Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Hispanic Alliance for Career Enhancement; Nashville (TN); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company seeks an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefit requests. This remote role requires a licensed pharmacist with BCOP certification, offering a competitive hourly rate and comprehensive benefits. Join a team dedicated to transforming healthcare with compassion and expertise.

Benefits

Health Plans

401(k)

Stock Purchase

Wellness Programs

Paid Time Off

Flexible Schedules

Qualifications

• Active pharmacist license in good standing.
• Minimum 2 years of clinical pharmacist experience.
• Clinical expertise in oncology therapies.

Responsibilities

• Evaluate and review prior authorization requests focusing on oncology.
• Identify and resolve workflow issues as a subject matter expert.
• Collaborate with internal and external partners to provide solutions.

Skills

Multitasking

Problem Solving

Attention to Detail

Effective Communication

Education

BS in Pharmacy or PharmD

Licensed Pharmacist

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 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. Your responsibilities include setting up cases accurately, reviewing clinical information, performing outreach to providers, and ensuring decisions comply with guidelines and timelines. Additionally, as an Oncology Pharmacist, you will assist front-line colleagues with oncology processes, provide training, and address escalations. Maintaining current oncology knowledge through education and certifications is essential. You will collaborate across departments to improve workflows and develop clinical training sessions, ensuring effective communication with stakeholders.

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

Primary Duties and Responsibilities

1. Evaluate and review prior authorization requests focusing on oncology, verifying insurance, interpreting guidelines, consulting providers, and conveying decisions promptly. (70%)
2. Identify and resolve workflow issues, supporting colleagues as a subject matter expert and handling escalations. (20%)
3. Assist with process changes as needed. (5%)
4. Collaborate with internal and external partners to provide solutions. (5%)

Education

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

Required Skills & Qualifications

• Active pharmacist license in good standing in your state.
• BCOP certification.
• Minimum 2 years of clinical pharmacist experience, including prior authorization.
• Proficiency in Microsoft Office; familiarity with Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, resource utilization, problem-solving, and attention to detail skills.
• Clinical expertise in oncology therapies.
• Adaptability to workflow changes.
• Effective team communication and mentorship abilities.
• Excellent written and verbal communication skills, maintaining confidentiality of PHI.

Essential Functions

• Regular attendance and willingness to work overtime when needed.
• Compliance with policies and ongoing training participation.

Physical Requirements

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

Work Environment

Remote work from an approved location.

Additional Details

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