[Hiring] Clinical Review Pharmacist @OI Infusion Services

Role Description

The Clinical Review Pharmacist is the quality gate that ensures every infusion order is clinically appropriate, payer-compliant, and accurately documented before authorization is requested. This role goes beyond medical necessity review and requires:

• Payer policy literacy
• Sharp attention to detail
• Proactive case-building for complex and off-label therapies
• Hands-on ownership of the denial response process from root-cause analysis through appeal or peer-to-peer support

The right candidate does not simply check boxes against a policy database. They:

• Read the full clinical picture
• Anticipate payer pushback before submission
• Communicate clearly and specifically with sites and navigators about what is needed and why
• Build an airtight case to overturn denials rather than placing the burden entirely on the referring provider

Qualifications

• Minimum 2 years of infusion therapy experience preferred (Hospital, home health, etc.)
• Proficient with Microsoft suite (Word, Excel, Outlook)
• Ability to work independently and manage multiple tasks
• Bachelor of Pharmacy or Doctor of Pharmacy preferred
• Current/clear pharmacist license within the state
• Minimum of four years of infusion pharmacy experience as a pharmacist preferred
• Experience with providing clinical education and support for specialty medications
• Thrives in a fast-paced working environment

Requirements

• Conduct thorough medical necessity review of infusion orders for both commercial and government payers across all designated drug therapies
• Review the full patient chart to determine whether the patient meets payer criteria
• Maintain and actively use the PGR policy database as the primary source of truth
• Apply consistent, templated communication standards when PGR review results in a required action
• Review and verify that each order is correctly dosed, flagging discrepancies with ordering providers
• Work with intake leaders to write specifically tailored LMN to overturn auth denials when necessary
• Assist the intake team with clinical guidance on auth denials
• Collaborate with clinical operations team on review and maintenance of order sets and drug preparation sheets
• Experience in navigating a fast-paced, high-volume environment with competing priorities

Benefits

• Salary: $100k-$130k
• Location: Remote

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions:

• Regularly required to talk or hear
• Frequently required to use hands or fingers, handle or feel objects, tools, or controls
• Occasionally required to stand, walk, sit, and reach with hands and arms
• Specific vision abilities required include close vision, distance vision, and the ability to adjust focus
• Noise level in the work environment is usually low to moderate