Clinical Reviewer

About Us
Squad Health provides navigation services and software to US medical practices to remove barriers to treatment ,especially prescription access.

Our services include benefits investigation, prior authorization support, patient assistance enrollment, pharmacy coordination, and patient engagement.

Our tea ---------- mbers operate as extensions of provider offices, supporting clinical staff through accurate documentation, clinical review, and consistent follow-up to help patients access therapy faster.

Job Summary
We are seeking an experienced Clinical Reviewer with a strong background in US specialty medication prior authorizations and clinical documentation review.

This role is responsible for reviewing patient charts, evaluating clinical information against payer requirements, supporting authorization submissions, and assisting provider offices in resolving medication access barriers efficiently and accurately.

The ideal candidate has experience interpreting clinical notes, treatment history, diagnosis documentation, and payer criteria across multiple specialty medications.

Key Responsibilities

• Review patient charts, clinical notes, diagnosis history, and treatment records to support medication authorization requests
• Evaluate documentation against payer-specific clinical requirements and authorization criteria
• Verify insurance benefits for specialty medications and procedures (Commercial, Medicare, Medicaid)
• Determine pharmacy vs. medical benefit pathways when applicable
• Complete clinical questionnaires and payer-specific authorization forms accurately
• Support submission and management of authorizations through payer portals, fax, and phone
• Track pending cases and follow up with payers until resolution
• Escalate urgent or STAT requests appropriately
• Collaborate with MDs, NPs, and clinic staff regarding denials, appeals, treatment plan updates, and Letters of Medical Necessity (LMNs)
• Assist in gathering supporting documentation for appeals and reconsiderations
• Support patient enrollment into copay assistance and patient assistance programs when needed
• Enroll patients into navigation programs and obtain required consent
• Maintain accurate and detailed documentation within internal systems and case trackers
• Participate in team discussions to resolve patient access barriers and improve operational workflows

Required Skills & Experience

• Minimum 2 years of US-based specialty medication prior authorization or clinical review experience
• Strong experience reviewing EMR/EHR clinical documentation
• Direct experience supporting GI, Dermatology, Rheumatology, Urology, and Allergy medication authorizations required
• Strong understanding of US insurance plans and payer requirements (Commercial, Medicare, Medicaid)
• Ability to interpret treatment history, diagnosis documentation, and clinical criteria accurately
• Strong attention to detail and structured documentation habits
• Excellent written and verbal English communication skills
• Ability to work full-time night shift aligned with EST hours

Preferred Qualifications

• Experience managing or mentoring Prior Authorization Specialists preferred
• Experience handling denials, appeals, and Letters of Medical Necessity
• Familiarity with specialty medication workflows and payer portal systems

To Apply
Subject: Clinical Reviewer
Please answer the following questions in your application message:

1. Please summarize your experience with US-based specialty medication prior authorizations or clinical review.
2. List 5 specialty medications you have frequently supported and can discuss during an interview.
3. Have you worked in a hospital, clinic, or provider office supporting medication authorizations or clinical reviews?
4. Please describe the platforms or systems you used.
5. Why are you looking to leave (or why did you leave) your previous employer?

Please attach a copy of your resume.
Applications without answers to all 5 questions will not be considered.