Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

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

Job summary

A leading health solutions company is seeking an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefits. This remote role involves evaluating prior authorization requests, training staff, and ensuring compliance with clinical guidelines. Candidates must have an active pharmacist license and BCOP certification, along with a minimum of 2 years of clinical experience.

Benefits

Medical benefits

401(k)

Stock purchase plan

Wellness programs

Qualifications

• Active pharmacist license in good standing required.
• Minimum of 2 years clinical pharmacist experience.
• Recent clinical focus in oncology therapy.

Responsibilities

• Evaluate and review prior authorization requests.
• Identify and resolve workflow issues.
• Collaborate with internal and external partners.

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 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 benefits requests. Your responsibilities include ensuring cases are accurately set up, reviewing clinical information for decisioning, performing outreach to providers, and ensuring decisions comply with guidelines and timelines. Additionally, as an Oncology Pharmacist, you will assist front-line colleagues by acting as a subject matter expert, providing training, answering questions, supporting production, and recommending process improvements. Maintaining current oncology knowledge through education and certification is essential. You will also partner with departmental leadership to identify workflow issues and develop clinical training sessions to enhance staff knowledge. Effective communication with internal and external stakeholders is crucial.

This is a remote role open to qualified candidates within the U.S. willing to work 9am-5:30pm EST, with flexibility for training or meetings.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Evaluate and review prior authorization requests and render coverage decisions based on clinical criteria, plan design, and compliance with guidelines. Verify insurance coverage, interpret clinical guidelines, consult healthcare providers, and communicate decisions promptly. (70%)
2. Identify and resolve workflow issues and support front-line colleagues as a subject matter expert, handling escalations and complex tasks. (20%)
3. Assist with process changes as needed for oncology reviews. (5%)
4. Collaborate with internal and external partners to provide solutions and support. (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 required.
• Minimum of 2 years clinical pharmacist experience, including prior authorization.
• Proficiency in Microsoft Office Suite; Access, Outlook, PowerPoint, and Visio preferred.
• Strong multitasking, problem-solving, and attention to detail skills.
• Recent clinical focus in oncology therapy.
• Effective communication skills and ability to work collaboratively.
• Ability to maintain confidentiality of PHI.

Essential Functions:

1. Regular attendance and willingness to work overtime when needed.
2. Compliance with all policies, procedures, and training requirements.

Physical Requirements:

• Sitting, talking on the phone, and computer use for extended periods.
• Reading on-screen information.

Work Environment:

Remote work from an approved location.

Additional Details:

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