Clinical Review Pharmacist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Clinical Review Pharmacist reviewing infusion orders for OI Infusion, which operates infusion management services and ambulatory specialty infusion centers. Building authorization and denial-appeal cases.
Responsibilities:
- Conduct thorough medical necessity review of infusion orders for commercial and government payers across designated drug therapies
- Review full patient charts for diagnosis, step therapy requirements, lab values, dosing, and continuation-of-therapy documentation
- Maintain and use the PGR policy database as the primary source of truth
- Flag and update payer policy changes quarterly with the Director of RCM
- Apply templated communication standards when review results require action by sites, navigators, or providers
- Review and verify order dosing and flag discrepancies with ordering providers
- Write tailored letters of medical necessity to overturn authorization denials when necessary
- Assist the intake team with clinical guidance on authorization denials and next steps
- Collaborate with clinical operations on order sets and drug preparation sheets
- Perform duties in a fast-paced, high-volume environment with competing priorities and evolving payer landscapes
Requirements:
- Minimum 2 years of infusion therapy experience preferred
- Minimum 4 years of infusion pharmacy experience as a pharmacist preferred
- Current and clear pharmacist license within the state
- Bachelor of Pharmacy or Doctor of Pharmacy preferred
- Proficiency with Microsoft Word, Excel, and Outlook
- Ability to work independently and manage multiple tasks
- Experience providing clinical education and support for specialty medications is a plus
- Ability to thrive in a fast-paced work environment
- Ability to evaluate patients against insurance company drug policies for treatment eligibility
- Must be legally authorized to work in the United States
- Must not require sponsorship now or in the future to work in the United States
Similar Jobs
Patient Care Coordinator, Specialty Pharmacy
Remote Patient Care Coordinator supporting Evernorth specialty pharmacy patients. Managing prior authorizations, claims, medication deliveries, and patient case coordination.
Oncology Patient Consult Staff Pharmacist
Oncology pharmacist counseling patients, verifying prescriptions, and coordinating medication orders for Evernorth Health Services. Ensuring accuracy, resolving dispensing issues, and supporting physicians and pharmacy teams remotely.
Certified Pharmacy Technician – Rare Disease
Certified Pharmacy Technician supporting rare-disease prescriptions for Accredo Specialty Pharmacy. Performing prescription data entry, quality assurance, and patient and provider outreach remotely in Tennessee.
Pharmacy Technician – Accredo Specialty Pharmacy
Remote Pharmacy Technician supporting Accredo Specialty Pharmacy patients with rare and chronic disease medications. Processing prescriptions, coordinating providers and insurers, and arranging timely medication shipments.
Specialty Pharmacy Liaison
Specialty Pharmacy Account Liaison supporting patient access and medication adherence for Valeris, a healthcare commercialization partner. Coordinating pharmacies, payers, patients, and providers while managing benefits, referrals, shipments, and escalations.
Pharmacy Validation Specialist
Pharmacy validation specialist verifying insurance eligibility and documenting claims data for healthcare intelligence company. Supporting coordination of benefits and accurate member records through carrier outreach.
Pharmacy Technician – Prior Authorizations
CVS Health pharmacy technician processing prior authorizations remotely for Aetna Pharmacy Prior Authorization. Reviewing clinical information, documenting decisions, and handling provider and pharmacy inquiries.
Prescribing Clinical Pharmacist – Part Time
Clinical Pharmacist managing long-term conditions, prescriptions, and medication reviews for NHS patients through Suvera’s virtual clinic. Providing remote, patient-facing care across partner general practices.
Vice President, Clinical Pharmacy – PBM
Vice President leading clinical pharmacy programs for ProCare Rx’s pharmacy benefit management business. Overseeing utilization management, cost containment, client consulting, and clinical program innovation.
Senior Manager, Pharmacy
Senior Pharmacy Manager overseeing utilization management and clinical review teams for Blue Cross NC, a nonprofit health insurer. Driving compliant pharmacy programs, operational performance, and medication-therapy strategy.
Supervisor, Specialty Pharmacy Services
Specialty Generics Operations Team Supervisor managing pharmacy service representatives and ensuring compliance. Leading team optimization and staff training for CVS Health operations.
Trade Pharmacy Representative
Trade Pharmacy Representative for Abbott managing sales and relationships in the Pretoria West region. Focusing on achieving sales goals and maintaining business relationships with pharmacies.
Clinical Account Consultant, Pharmacy
Pharmacy Consultant responsible for managing pharmacy programs at HCSC. Supporting the development and administration of innovative clinical programs to enhance client relationships.
Pharmacy Technician – Refill Authorization
Pharmacy Technician managing refill authorizations at Intermountain Health. Collaborating remotely and ensuring timely access to prescribed medications for patient care.
Patient Outreach Specialist, Pharmacy Technician
Patient Outreach Specialist making outbound calls to eligible patients and enrolling them with Shields Partner Pharmacy. Educating patients on services and maintaining confidentiality.
Pharmacy Technician – Anticoagulation
Pharmacy Technician supporting anticoagulation therapy across Colorado and Montana. Collaborating with pharmacists and advanced practice providers to ensure safe, high-quality patient care.
VP, Pharmacy Spend Management Delivery
VP Pharmacy providing strategic leadership for pharmacy programs and client relationships at Vizient. Driving financial success and executive collaboration amidst national pharmacy initiatives.
Enhanced Case Management Pharmacist
Enhanced Case Management Pharmacist at Allied Benefit Systems engaging members and supporting their health journey through clinical expertise and compassionate communication.
PRN Specialty Clinical Pharmacist
PRN Specialty Clinical Pharmacist role providing comprehensive pharmaceutical care for patients. Supporting multiple specialty areas and participating in departmental performance improvement efforts.
Medicines Management Pharmacist
Medicines Management Pharmacist improving access to mental health care in the UK. Collaborating on medicines safety and effectiveness in a remote position with Psychiatry UK.