Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

CVS Health; Lincoln (NE); On-site; Full time

Job summary

A leading health solutions company is seeking an Oncology RPh Advisor to support Medicare Part D members. This remote role involves evaluating prior authorization requests, collaborating with teams, and maintaining oncology knowledge. The ideal candidate will have a pharmacist license, BCOP certification, and clinical experience in oncology.

Benefits

Medical Benefits

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.
• Expertise in oncology therapies.

Responsibilities

• Evaluate and review prior authorization requests, ensuring compliance with guidelines.
• Identify and solve workflow issues, acting as a subject matter expert.
• Collaborate with partners to provide solutions and support.

Skills

Problem Solving

Attention to Detail

Effective Communication

Multitasking

Resourcefulness

Education

BS in Pharmacy or PharmD

BCOP certification

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 uniquely 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, performing outreach to providers, and ensuring decisions comply with guidelines and timelines. You will also assist front-line colleagues with oncology processes, provide on-the-job training, and help develop clinical training sessions. Maintaining current oncology knowledge through education and certifications is essential. Collaboration with various teams and leadership is required.

This is a remote role open 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: Make coverage determinations based on clinical criteria, plan design, and guidelines, ensuring prompt and efficient communication with providers and stakeholders. 70%
2. Identify and solve workflow issues: Support front-line staff, act as a subject matter expert, and address escalations. 20%
3. Assist with process changes: Support review process modifications as needed. 5%
4. Collaborate with partners: Provide solutions and support to internal and external stakeholders. 5%

EDUCATION:

BS in Pharmacy or PharmD. Required: Licensed Pharmacist and BCOP certification.

REQUIRED SKILLS & MINIMUM QUALIFICATIONS:

• Active pharmacist license in good standing.
• BCOP certification.
• At least 2 years of clinical pharmacy experience, including prior authorization.
• Proficiency in Microsoft Office; Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, resourcefulness, problem-solving, and attention to detail.
• Expertise in oncology therapies.
• Adaptability to workflow changes.
• Effective communication skills for diverse audiences.
• Ability to maintain PHI confidentiality.

ESSENTIAL FUNCTIONS:

• Regular attendance.
• Willingness for overtime when necessary.
• Compliance with policies and procedures.
• Participation in ongoing training.

PHYSICAL REQUIREMENTS:

• Prolonged sitting and computer use.
• Extended phone conversations.

WORK ENVIRONMENT:

Remote work from an approved location.

ADDITIONAL DETAILS:

Full-time, 40 hours/week. Pay range: $45.43 - $101.54/hour, depending on experience and other factors. Benefits include medical, 401(k), stock purchase, wellness programs, and more. Application deadline: 05/27/2025.