Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Hispanic Alliance for Career Enhancement; Dover (DE); Remote; Full time

Job summary

A leading health solutions company seeks an Oncology RPh Advisor to support Medicare Part D members and providers. This remote role involves evaluating pharmacy benefits requests, collaborating with various departments, and maintaining current oncology knowledge. Candidates must hold a valid pharmacist license and BCOP certification, with a focus on clinical expertise and effective communication.

Benefits

Medical plans

401(k)

Stock purchase

Wellness programs

Paid time off

Flexible schedules

Family leave

Tuition assistance

Qualifications

• Active pharmacist license in good standing.
• Minimum 2 years clinical pharmacy experience, including prior authorization.
• Clinical expertise in oncology therapies.

Responsibilities

• Evaluate and review prior authorization requests.
• Identify and address workflow issues.
• Collaborate with partners to develop solutions.

Skills

Multitasking

Problem-solving

Attention to detail

Effective communication

Teamwork

Education

BS in Pharmacy or PharmD

Board Certified Oncology Pharmacist (BCOP)

Tools

Microsoft Office

Access

Outlook

PowerPoint

Visio

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues—caring for people where, when, and how they choose in a way that is more connected, convenient, and compassionate. We do all this with heart, every day.

Position Summary

As an Oncology RPh Advisor in Government Services, you will support Medicare Part D members and providers with pharmacy benefits requests. Your responsibilities include setting up cases accurately, reviewing clinical information for decision-making, reaching out to providers for additional information, and ensuring decisions comply with guidelines and timelines. Additionally, as an Oncology Pharmacist, you will assist front-line colleagues with oncology processes, act as a subject matter expert, provide training, and support workflow improvements. Maintaining current oncology knowledge through education and certification is essential. You will collaborate with various departments and leadership to identify issues and develop clinical training programs.

This is a remote role open to qualified candidates within the United States. Candidates must be available to work 9am-5:30pm EST, Monday through Friday, with flexibility for training and meetings.

Primary Duties and Responsibilities

1. Evaluate and review prior authorization requests (70%): Verify coverage, interpret clinical criteria, consult providers, and communicate decisions promptly and accurately.
2. Identify and address workflow issues (20%): Support front-line staff, act as SME, and handle escalations to improve performance.
3. Assist with process changes (5%): Support oncology review process updates as needed.
4. Collaborate with partners (5%): Work with internal and external teams to develop solutions for stakeholders.

Education

BS in Pharmacy or PharmD. Licensed Pharmacist and BCOP certification required.

Required Skills & Qualifications

• Active pharmacist license in good standing.
• Board Certified Oncology Pharmacist (BCOP).
• Minimum 2 years clinical pharmacy experience, including prior authorization.
• Proficiency in Microsoft Office (Excel, Word); knowledge of Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, problem-solving, and attention to detail skills.
• Clinical expertise in oncology therapies.
• Effective communication and teamwork skills.
• Ability to handle PHI confidentiality.

Additional Information

• Regular attendance and willingness to work overtime when needed.
• Compliance with all policies and ongoing training participation.

Physical and Work Environment

Sitting, talking, and computer use for extended periods. Work from a home location. Weekly hours: 40. Time type: Full-time.

Compensation and Benefits

Pay range: $45.43 - $101.54/hour. Compensation depends on experience, education, and location. Eligible for bonuses and incentives.

Benefits include medical plans, 401(k), stock purchase, wellness programs, paid time off, flexible schedules, family leave, tuition assistance, and more. Details at https://jobs.cvshealth.com/us/en/benefits.

Application deadline: 05/27/2025. Qualified applicants with records will be considered per law.