[Hiring] Infusions and Specialty Pharmacy Documentation and Criteria Reviewer @Tennr

Role Description

If you’ve worked in front-end intake, operations compliance, authorizations submission, clinical review, or audit/appeals review in the specialty pharmaceutical / infusions therapy space, this is an opportunity to apply that experience in a new way. We’re growing our documentation and criteria review team to help ensure our 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 do or do not align with real-world payer standards.

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

Qualifications

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

Requirements

• 4+ years working in infusions/SP, ideally in intake, documentation review, case management, and clinical review
• You are 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

Benefits

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