Infusion Clinical Review Coordinator

Soleo Health•Frisco, TX

16d•Remote

About The Position

Soleo Health is seeking an Infusion Clinical Review Coordinator to support its Specialty Infusion Pharmacy. This remote U.S. position works closely with departments across the organization to research complex patient cases and provide accurate, timely clinical reviews. The role helps secure authorization and mitigate technical and clinical denial risk, and works to resolve denials using nationally recognized criteria for appeals. The coordinator reviews patient and payer clinical information to assess medical necessity, identifies and requests supporting documentation, develops clinical support packets, and prepares fact-based denial appeals. The role also maintains clinical support resources, keeps current on payer policies and formularies, assists with post-service denials and appeals, supports outcome programs, and provides interdepartmental training. The schedule is Monday through Friday, 8:30 a.m. to 5 p.m. Mountain or Pacific time. Specialty infusion pharmacy experience is required.

Requirements

Specialty infusion pharmacy experience is required.
Experience with denial support, clinical reviews, and appeals for infusions and specialty pharmacy is required.
Bachelor’s degree in a healthcare field or three years of experience in a qualified position.
Excellent written, oral, and presentation communication skills; customer service and interpersonal skills.
Flexible communication style, strong listening skills, and ability to work as a motivated team player.
Ability to handle stress, meet program objectives, and manage time effectively.
Self-starter who accepts responsibility and accountability and is results-oriented.
Competence using Word, Excel, and PowerPoint.
Ability to communicate effectively with all levels of the organization.
Enthusiastic support for Soleo Health’s philosophy and goals.
Ability to work remotely Monday through Friday, 8:30 a.m.–5 p.m. Mountain or Pacific time.

Nice To Haves

Medical Assistant, LPN, or RN qualification or experience is preferred.

Responsibilities

Complete timely prior authorization reviews by evaluating patient clinical information and payer criteria to determine whether services meet medical necessity requirements.
Review and interpret patient progress notes, laboratory reports, infusion summaries, imaging reports, and plans of care.
Identify medical documentation that satisfies payer medical policy criteria.
Request additional clinical information when needed to make a decision or determine next steps.
Assist in creating clinical support packets for initial prior authorizations and subsequent appeals.
For authorization denials, construct and document concise, fact-based clinical cases supporting appeals using appropriate medical necessity criteria and relevant clinical facts.
Create and maintain clinical support resources, including appeal templates, journal articles, and reference tools; locate supporting clinical evidence when existing resources are unavailable.
Stay current on top payer-covered services, medical necessity requirements, formulary details, and payer medical policy resources.
Assist with post-service insurance denials and appeals.
Participate in outcome programs, including data entry, reporting, and patient calls as needed to complete denial-support tasks.
Provide interdepartmental training on major disease states and specialty drugs, clinical requirements, and prior authorization and appeal best practices.