Infusions and Specialty Pharmacy Documentation and Criteria Reviewer

Tennr

5d • Remote

About The Position

Tennr is seeking to grow its documentation and criteria review team to ensure its platform accurately applies payer authorization and medical necessity criteria. This is a detail-oriented, fully-remote, hands-on role focused on reviewing clinical documentation, assessing model-generated authorization/clinical review outcomes, and identifying when decisions align with real-world payer standards. The role involves reviewing model outputs to improve criteria determinations, flagging incorrect determinations with structured feedback, comparing documentation against Medicare, Medicaid, and commercial payer coverage policies, analyzing source materials to validate qualification logic, working closely with internal teams to refine prompting logic and improve documentation review standards, and maintaining clear documentation of findings and contributing to process improvements.

Requirements

• Hands-on infusions/SP experience in roles such as intake, documentation review, case management, and clinical review
• Confident identifying when documentation meets or fails to meet payer requirements
• Comfortable reviewing insurance coverage policies and applying them to real-world cases
• Highly organized, detail-focused, and confident making policy-based decisions
• Work well independently and value open communication within a remote team setting

Nice To Haves

• 4+ years working in infusions/SP, ideally in intake, documentation review, case management, and clinical review
• Tech-savvy and comfortable using AI tools in your day-to-day work to improve accuracy and efficiency
• Familiarity with Medicare, Medicaid, and commercial payer guidelines for infusions/SP
• Understanding of HCPCS codes, NDCs, and common infusions/SP drug categories across therapeutic areas (e.g., neurology, inflammation and immunology, etc.)
• Experience with audits, prior authorizations, and appeals is a strong plus
• Familiarity with decision logic or rules-based platforms is helpful but not required

Responsibilities

• Review the model’s outputs to improve criteria determinations
• Flag incorrect determinations, including false positives, false negatives, and unclear logic, with structured feedback
• Compare documentation against Medicare, Medicaid, and commercial payer coverage policies
• Analyze source materials (insurance policies, LCDs, etc.) to help validate qualification logic
• Work closely with internal teams to refine prompting logic and improve documentation review standards
• Maintain clear documentation of findings and contribute to process improvements

Benefits

• Unlimited PTO
• Full-Remote Flexibility
• 100% paid employee health benefit options
• Employer-funded 401(k) match
• Competitive parental leave

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed