Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Agnello & Rogers; Springfield (IL); On-site; Full time

Job summary

A leading health solutions company seeks an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefit requests. Responsibilities include evaluating prior authorization requests, collaborating with teams, and maintaining oncology knowledge. This remote role requires a licensed pharmacist with clinical experience and effective communication skills.

Benefits

Medical benefits

401(k)

Stock purchase

Wellness programs

Qualifications

• Active pharmacist license in good standing.
• Minimum 2 years clinical pharmacist experience, including prior authorization.
• Recent oncology clinical expertise.

Responsibilities

• Evaluate prior authorization requests focusing on oncology.
• Identify and resolve workflow issues.
• Collaborate with partners to provide solutions.

Skills

Multitasking

Problem-Solving

Communication

Attention to Detail

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 benefit requests. Your responsibilities include ensuring accurate case setup, reviewing clinical information for decision-making, outreach to providers for additional info, and ensuring decisions comply with guidelines and timelines. You will also assist front-line colleagues as a subject matter expert, provide training, and support process improvements. Maintaining current oncology knowledge through ongoing education is essential. You will collaborate with various teams and leadership to improve workflow and outcomes. This is a remote role within the U.S., requiring availability from 9 am to 5:30 pm EST, with flexibility as needed.

Primary Duties and Responsibilities

1. Evaluate and review prior authorization requests: Focus on oncology, verify coverage, interpret guidelines, consult providers, and communicate decisions promptly and efficiently. (70%)
2. Identify and resolve workflow issues: Support front-line staff, act as SME, and address escalations. (20%)
3. Assist with review process changes: Support standard or client-specific updates. (5%)
4. Collaborate with partners: Provide solutions for internal and external stakeholders. (5%)

Education

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

Required Skills & Qualifications

• Active pharmacist license in good standing.
• Board Certified Oncology Pharmacist (BCOP).
• Minimum 2 years clinical pharmacist experience, including prior authorization.
• Proficiency in Microsoft Office Suite; familiarity with Access, Outlook, PowerPoint, Visio preferred.
• Strong multitasking, resourcefulness, problem-solving, and attention to detail.
• Recent oncology clinical expertise.
• Effective communication skills, both written and verbal.
• Ability to maintain confidentiality of PHI.

Essential Functions

1. Attendance and punctuality.
2. Willingness to work overtime when needed.
3. Compliance with all policies and regulations.
4. Participation in ongoing training.

Physical Requirements

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

Work Environment

Remote work from an approved location.

Additional Details

40 hours/week, full-time, pay range $45.43 - $101.54/hour. Benefits include medical, 401(k), stock purchase, wellness programs, and more. Application deadline: 05/27/2025. Qualified applicants with criminal records will be considered per law.