Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Hispanic Alliance for Career Enhancement; Providence (RI); Remote; USD 100,000 - 125,000; Full time

Job summary

A leading healthcare company seeks an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefit requests. The role requires a BS in Pharmacy or PharmD, BCOP certification, and involves evaluating authorization requests, collaborating with teams, and maintaining oncology knowledge. This remote position offers a competitive salary and benefits.

Benefits

Medical

401(k)

Stock purchase

Wellness programs

Paid time off

Flexible schedules

Qualifications

• Active pharmacist license in good standing.
• 2+ years clinical pharmacy experience, including prior authorization.
• Recent oncology experience and ability to adapt to workflow changes.

Responsibilities

• Evaluate and review authorization requests focusing on oncology.
• Identify and solve workflow issues as a subject matter expert.
• Assist with process changes and collaborate with partners.

Skills

Multitasking

Problem-Solving

Communication

Collaboration

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 more connected, convenient, and 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, act as a subject matter expert, provide training, and help streamline systems and processes. Maintaining current oncology knowledge through education and certification is essential. The role involves collaboration with various teams and departments, including providing clinical training and ensuring effective communication.

This is a remote role within the United States. Candidates must be available to work 9am-5:30pm EST, with flexibility for training and meetings.

Primary Duties and Responsibilities

1. Evaluate and review authorization requests: Focus on oncology, verify coverage, interpret guidelines, and communicate decisions efficiently. (70%)
2. Identify and solve workflow issues: Support front-line staff and address escalations as a subject matter expert. (20%)
3. Assist with process changes: Support oncology review process updates as needed. (5%)
4. Collaborate with partners: Provide solutions and support across teams. (5%)

Education

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

Required Skills & Qualifications

• Active pharmacist license in good standing.
• BCOP certification.
• 2+ years clinical pharmacy experience, including prior authorization.
• Proficiency in Microsoft Office; familiarity with Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, problem-solving, and communication skills.
• Recent oncology experience and ability to adapt to workflow changes.
• Effective team collaboration and mentorship abilities.
• Commitment to confidentiality of PHI.

Additional Information

Attendance is expected, with mandatory overtime when necessary. Adherence to policies and ongoing training are required.

Physical Requirements: Sitting, talking on the phone, computer use, reading screens.

Work Environment: Remote, work-from-home setup.

Hours and Compensation: 40 hours/week, full-time. Pay range: $45.43 - $101.54/hour, based on experience and other factors. Eligible for bonuses and incentives.

Benefits: Medical, 401(k), stock purchase, wellness programs, paid time off, flexible schedules, and more. Details at https://jobs.cvshealth.com/us/en/benefits.

Application deadline: 05/27/2025. Qualified applicants with records will be considered per applicable laws.