Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Hispanic Alliance for Career Enhancement; Kalamazoo (MI); Remote; Full time

Job summary

A leading healthcare organization seeks an Oncology RPh Advisor to support Medicare Part D members. This remote role involves evaluating pharmacy benefit requests, collaborating with teams, and providing training. Candidates must hold a valid pharmacist license and BCOP certification, with a strong background in clinical pharmacy and oncology.

Benefits

Health plans

401(k)

Stock purchase

Wellness programs

Qualifications

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

Responsibilities

• Evaluate prior authorization requests and determine coverage based on clinical criteria.
• Support colleagues with oncology processes and handle escalations.
• Collaborate with internal and external partners to provide solutions.

Skills

Multitasking

Problem-solving

Attention to detail

Effective communication

Adaptability

Education

BS in Pharmacy or PharmD

BCOP certification

Tools

Microsoft Office

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.

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 ensuring accurate case setup, reviewing clinical information, outreach to providers, and making compliant decisions per guidelines and timelines. Additionally, as an Oncology Pharmacist, you will support front-line colleagues with oncology processes, act as a subject matter expert, provide training, and contribute to process improvements. Maintaining current oncology knowledge through self-education and certifications is essential. Collaboration with various teams and departments is required.

This is a remote role open within the U.S., requiring availability from 9 am to 5:30 pm EST, with flexibility for training and meetings.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Evaluate and review: All prior authorization requests, determine coverage based on clinical criteria, plan design, and oncology focus. Verify insurance, interpret guidelines, consult providers, and communicate decisions promptly. (70%)
2. Identify and resolve workflow issues: Support colleagues with oncology processes, act as SME, handle escalations, and perform complex tasks. (20%)
3. Assist with process changes: Support review process updates as needed. (5%)
4. Collaborate: Work with internal and external partners to provide solutions. (5%)

EDUCATION

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

REQUIRED SKILLS & QUALIFICATIONS

• Active pharmacist license in good standing.
• BCOP certification.
• At least 2 years of clinical pharmacy experience, including prior authorization.
• Proficiency in Microsoft Office; familiarity with other tools preferred.
• Strong multitasking, resourcefulness, problem-solving, and attention to detail.
• Recent oncology expertise.
• Adaptability to workflow changes.
• Effective team communication and mentorship skills.
• Excellent written and verbal communication skills.
• Ability to handle PHI confidentially.

ESSENTIAL FUNCTIONS

1. Attendance and punctuality.
2. Willingness to work overtime if needed.
3. Compliance with policies and accuracy in processing information.
4. Participation in ongoing training.

PHYSICAL REQUIREMENTS

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

WORK ENVIRONMENT

Work from home in an approved location.

ADDITIONAL INFORMATION

40 hours/week, full-time. Pay range: $45.43 - $101.54/hour, dependent on experience and location. Benefits include health plans, 401(k), stock purchase, wellness programs, and more. Application deadline: 05/27/2025.