Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

Hispanic Alliance for Career Enhancement; Trenton (NJ); Remote; Full time

Job summary

A leading health solutions company seeks an Oncology RPh Advisor to support Medicare Part D members with pharmacy benefit requests. This remote role requires a licensed pharmacist with oncology expertise, offering a competitive salary and benefits.

Benefits

Health plans

401(k)

Stock purchase

Wellness programs

Qualifications

• Active pharmacist license in good standing.
• At least 2 years of clinical pharmacist experience.
• Recent clinical expertise in oncology therapy.

Responsibilities

• Evaluate and review prior authorization requests.
• Identify and solve workflow issues.
• Collaborate with internal and external teams.

Skills

Multitasking

Problem Solving

Attention to Detail

Communication

Collaboration

Education

BS in Pharmacy or PharmD

Board Certified Oncology Pharmacist (BCOP)

Tools

Microsoft Office Suite

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 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, act as a subject matter expert, provide training, and contribute to process improvements. Maintaining current oncology knowledge through education and certification, and collaborating with various teams, are essential aspects of this role.

This is a remote position open to qualified candidates within the United States. Candidates must be willing to work 9am-5:30pm EST, Monday through Friday, with flexibility for training or meetings.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Evaluate and review prior authorization requests: Render coverage decisions based on clinical criteria and plan design, verify insurance, interpret guidelines, consult providers, and communicate decisions promptly. (70%)
2. Identify and solve workflow issues: Support front-line staff with oncology processes, act as SME, and address escalations. (20%)
3. Assist with review process changes: Support standard or client-specific oncology review modifications. (5%)
4. Collaborate with partners: Work with internal and external teams to provide solutions. (5%)

EDUCATION

BS in Pharmacy or PharmD

Required: Licensed Pharmacist and BCOP

REQUIRED SKILLS & OTHER MINIMUM QUALIFICATIONS:

• Active pharmacist license in good standing in the state of residence
• Board Certified Oncology Pharmacist (BCOP)
• At least 2 years of clinical pharmacist experience, including prior authorization
• Proficiency in Microsoft Office Suite; Access, Outlook, PowerPoint, Visio preferred
• Strong multitasking, resource utilization, problem-solving, and attention to detail skills
• Recent clinical expertise in oncology therapy
• Adaptability to workflow changes
• Effective team collaboration and mentorship abilities
• Excellent communication skills, both written and verbal
• Ability to maintain confidentiality of PHI

ESSENTIAL FUNCTIONS:

• Regular attendance
• Willingness to work overtime when needed
• Compliance with policies and procedures
• Participation in ongoing training

PHYSICAL REQUIREMENTS:

• Sitting for long periods
• Extended phone and computer use
• Reading screens

WORK ENVIRONMENT:

Work from home

ADDITIONAL INFORMATION:

Weekly hours: 40; Full-time; Pay range: $45.43 - $101.54/hour. Benefits include health plans, 401(k), stock purchase, wellness programs, and more. Application deadline: 05/27/2025.