Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

CVS Health; Denver (CO); Remote; USD 100,000 - 125,000; Full time

Job summary

CVS Health is seeking an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefit requests. This remote role involves evaluating prior authorizations, collaborating with teams, and maintaining oncology knowledge. The ideal candidate will have a BS in Pharmacy or PharmD, BCOP certification, and strong problem-solving skills.

Benefits

Medical

401(k)

Stock Purchase

Wellness Programs

Qualifications

• Active pharmacist license in good standing required.
• BCOP certification and at least 2 years of clinical pharmacist experience.

Responsibilities

• Evaluate and review prior authorization requests.
• Identify and resolve workflow issues.
• Assist with process changes.

Skills

Problem Solving

Communication

Attention to Detail

Multitasking

Education

BS in Pharmacy

PharmD

Tools

Microsoft Office Suite

Access

Outlook

PowerPoint

Visio

Job description

CO Salary Range: USD 60.58 - 101.54 per hour

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 uniquely more connected, more convenient, and more compassionate. And 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 decisioning, outreach 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 internal teams and leadership to identify issues and develop solutions. This is a remote role within the U.S., requiring availability from 9am-5:30pm EST, with flexibility for training or meetings.

Primary Duties and Responsibilities

1. Evaluate and review prior authorization requests: Render coverage decisions based on clinical criteria and plan design, verify insurance coverage, interpret guidelines, and communicate decisions promptly to all stakeholders. (70%)
2. Identify and resolve workflow issues: Support front-line staff, act as SME, and handle escalations to improve performance. (20%)
3. Assist with process changes: Support oncology review process adjustments as needed. (5%)
4. Collaborate with partners: Work with internal and external teams to provide effective solutions. (5%)

Education

BS in Pharmacy or PharmD. Licensed Pharmacist and Board Certified Oncology Pharmacist (BCOP) required.

Required Skills & Qualifications

• Active pharmacist license in good standing in the state of residence.
• BCOP certification.
• At least 2 years of clinical pharmacist experience, including prior authorization.
• Proficiency in Microsoft Office Suite; familiarity with Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, resource utilization, problem-solving, and attention to detail skills.
• Expertise in oncology therapies with recent focus in the field.
• Adaptability to workflow changes and shifting priorities.
• Effective team collaboration and mentorship abilities.
• Excellent communication skills, both written and verbal.
• Ability to maintain confidentiality of PHI.

Essential Functions

• Maintain regular attendance.
• Work mandatory overtime when necessary.
• Ensure compliance with policies, procedures, and regulations.
• Participate in ongoing training.

Physical Requirements

• Sitting for long periods.
• Extended phone and computer use.
• Reading screens.

Work Environment

Remote work from an approved location.

Additional Details

Expected weekly hours: 40. Salary range: $45.43 - $101.54. Compensation includes potential bonuses and incentives. Benefits include medical, 401(k), stock purchase, wellness programs, and more. Application deadline: 05/27/2025.