Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Hispanic Alliance for Career Enhancement; Harrisburg (Dauphin County); 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 role involves evaluating prior authorization requests, collaborating with teams, and requires a BS in Pharmacy or PharmD along with BCOP certification. Candidates should possess strong problem-solving skills and recent oncology therapy expertise.

Qualifications

• Active pharmacist license in good standing required.
• At least 2 years of clinical pharmacy experience, including prior authorization.
• Recent oncology therapy expertise is essential.

Responsibilities

• Evaluate and review prior authorization requests based on clinical criteria.
• Support frontline staff with oncology processes and handle escalations.
• Collaborate with internal and external teams to deliver solutions.

Skills

Multitasking

Problem Solving

Attention to Detail

Effective Communication

Education

BS in Pharmacy or PharmD

Board Certified Oncology Pharmacist (BCOP)

Tools

Microsoft Office Suite

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, more convenient, and more 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, outreach to providers, and ensuring decisions comply with guidelines and timelines. You will also assist front-line colleagues with oncology processes, provide training, and develop clinical knowledge in oncology therapies. Collaboration with various internal teams is essential.

This is a work-from-home role open to qualified candidates within the U.S., with working hours from 9 am to 5:30 pm EST, Monday to Friday, with flexibility for training or meetings.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Evaluate and review prior authorization requests: Render coverage decisions based on clinical criteria, plan design, and compliance. Ensure prompt communication with healthcare providers and stakeholders. (70%)
2. Identify and solve workflow issues: Support frontline staff with oncology processes, act as SME, and handle escalations. (20%)
3. Assist with process changes: Support modifications to oncology review procedures as needed. (5%)
4. Collaborate with partners: Work with internal and external teams to deliver solutions. (5%)

EDUCATION:

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

REQUIRED SKILLS & OTHER 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 Suite; familiarity with Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, resource utilization, problem-solving, and attention to detail skills.
• Recent oncology therapy expertise.
• Effective communication skills, both written and verbal.
• Ability to maintain confidentiality of PHI.

ESSENTIAL FUNCTIONS:

• Regular attendance and willingness to work overtime if needed.
• Compliance with all policies and procedures.
• Participation in ongoing training.

PHYSICAL REQUIREMENTS:

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

WORK ENVIRONMENT:

Remote work from an approved location.

OTHER DETAILS:

• 40 hours/week, full-time.
• Pay range: $45.43 - $101.54/hour, based on experience and other factors.