Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Acadiana Renal Physicians; Baton Rouge (LA); Remote; Full time

Job summary

A leading health solutions company seeks an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefit requests. This remote full-time role involves evaluating prior authorization requests, collaborating with internal teams, and requires a BS in Pharmacy or PharmD along with BCOP certification. Competitive salary and benefits offered.

Benefits

Health plans

401(k)

Stock purchase

Wellness programs

Qualifications

• Active pharmacist license in good standing.
• At least 2 years of clinical pharmacy experience, including prior authorization.
• Recent clinical focus in oncology therapies.

Responsibilities

• Evaluate prior authorization requests and make coverage determinations.
• Support colleagues with oncology processes and handle escalations.
• Assist with process changes and collaborate with partners.

Skills

Problem-solving

Attention to detail

Effective communication

Multitasking

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 it all with heart, each and every day.

POSITION SUMMARY:

As an Oncology RPh Advisor in Government Services, you will support Medicare Part D members and providers with pharmacy benefit requests. Responsibilities include setting up cases accurately, reviewing clinical information for decision-making, outreach to providers for additional info, and ensuring decisions comply with guidelines and timelines. You will also assist front-line colleagues with oncology processes, provide training, answer questions, support workflows, and stay current with oncology therapies through ongoing education. Collaboration with various internal teams and departments is essential.

This is a remote role open to qualified candidates within the U.S., working 9am-5:30pm EST, with flexibility for training and meetings.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Evaluate and review prior authorization requests: Make coverage determinations based on clinical criteria and plan design, verify insurance, interpret guidelines, and communicate decisions promptly to healthcare providers and patients. (70%)
2. Identify and resolve workflow issues: Support colleagues with oncology processes, act as SME, and handle escalations. (20%)
3. Assist with process changes: Support review process modifications as needed. (5%)
4. Collaborate with partners: Provide solutions and support across teams. (5%)

EDUCATION:

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

REQUIRED SKILLS & MINIMUM QUALIFICATIONS:

• Active pharmacist license in good standing.
• Board Certified Oncology Pharmacist (BCOP).
• At least 2 years of clinical pharmacy experience, including prior authorization.
• Proficiency in Microsoft Office; familiarity with Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, resourcefulness, problem-solving, and attention to detail.
• Recent clinical focus in oncology therapies.
• Effective communication skills and ability to maintain confidentiality.

ESSENTIAL FUNCTIONS:

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

Physical Requirements:

• Sitting, talking on phone, computer use, reading screens for extended periods.

Work Environment:

Remote from an approved location.

Additional Details:

40 hours/week, full-time, pay range $45.43 - $101.54/hour, with benefits including health plans, 401(k), stock purchase, wellness programs, and more. Application deadline: 05/27/2025.