Infusion Clinical Review Coordinator

Soleo Health

. Complete prior authorization reviews using clinical expertise to evaluate patient clinicals and payer clinical criteria .

Posted 10/23/2026full-timeRemote • United StatesMid-LevelSenior💰 $65,000 - $80,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization reviews and clinical evaluations, with a strong focus on specialty infusion pharmacy practices and appeals processes. Proficient in creating clinical support documentation and maintaining resources to support decision-making and compliance with payer policies.

Highest-signal resume keywords

Specialty Infusion Pharmacy ExperienceClinical Review and Denial SupportPrior Authorization and Appeals ExpertiseExcellent Communication SkillsBachelor’s Degree in Healthcare Field

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical EvaluationMedical Documentation ReviewData EntryClinical Case ConstructionPayer Medical Policy Knowledge

Soft Skills

Excellent CommunicationCustomer ServiceInterpersonal SkillsTime ManagementTeam Player

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft PowerPoint

Certifications & Qualifications

Medical AssistantLicensed Practical Nurse (LPN)Registered Nurse (RN)

Industry Keywords

Prior AuthorizationAppeals ProcessMedical Necessity RequirementsInfusion TherapyPayer-Covered Services

About the role

Key responsibilities & impact

Complete prior authorization reviews using clinical expertise to evaluate patient clinicals and payer clinical criteria
Review patient progress notes, lab reports, infusion summaries, imaging reports, and plans of care
Identify medical documentation satisfying payer medical policy criteria
Request additional clinical information when needed to render decisions or determine next steps
Create clinical support packets for initial prior authorizations and subsequent appeals
Construct and document fact-based clinical cases supporting appeals after authorization denials
Create and maintain a library of clinical support resources, appeal templates, journal articles, and reference tools
Search for supporting clinical evidence when existing resources are unavailable
Stay current on payer-covered services, medical necessity requirements, formulary details, and payer medical policies
Assist with post-service insurance denials and appeals
Participate in outcome programs, including data entry, reporting, and patient calls
Provide interdepartmental training on disease states, specialty drugs, clinical requirements, and prior authorization and appeal best practices

Requirements

What you’ll need

Must be able to work Monday-Friday, 8:30am-5pm Mountain or Pacific time
Specialty Infusion Pharmacy experience required
Must have experience with denial support, clinical reviews, and appeals for infusions and specialty pharmacy
Preferred qualifications are Medical Assistant, LPN, RN
Bachelor’s degree in healthcare field or 3 years in a qualified position
Excellent communication skills (written, oral, and presentation), customer service, and interpersonal skills
Flexible communication style, highly motivated team player with excellent listening skills
Able to handle stress to meet identified program objectives and manage time effectively
Self-starter who takes responsibility, is comfortable with accountability, and is results oriented
Competent in the use of Word, Excel, and PowerPoint
Must be able to communicate effectively with all levels of the organization within Soleo Health
Must enthusiastically support Soleo Health’s philosophy and goals

Benefits

Comp & perks

Competitive Wages
Flexible schedules
401(k) with a match
Referral Bonus
Paid Time Off
Annual Merit Based Increases
No Weekends or Holidays
Affordable Medical, Dental, and Vision Insurance Plans
Company Paid Disability and Basic Life Insurance
HSA and FSA (including dependent care) options
Education Assistant Program