Clinical Pharmacist - Prior Authorization/Oncology (BCOP Required)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Clinical Pharmacist is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed. This position requires the Clinical Pharmacist to hold Board Certified Oncology Pharmacist (BCOP) credential at time of hire.

This position is responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education.

Responsibilities:

1.) Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. 

2.) Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.

3.) Responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership.

4.) Assist with standard or client specific oncology review process changes as needed. 

5.) Assist with writing Work Instructions when needed.

6.) Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.

7.) Provide feedback of trends pertinent to oncology reviews.

8.) Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.

9.) Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.

This is a remote role, open to qualified candidates within the United States who currently hold Board Certified Oncology Pharmacist (BCOP) certification. Colleague will be responsible for maintaining this credential and meeting all ongoing requirements of credentialing body.

Essential Functions:

1. Regular and predictable attendance

2. Colleague may be required to work mandatory overtime/extended work week when needed

3. Colleague may be required to travel when needed

4.  Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.

5.  Adhere to all policies and procedures

6.  Attend on going training and development meetings as assigned

Work Environment

This is a fully remote, work-at-home role. Colleague is responsible for maintaining a HIPAA-compliant remote workspace.
Must be able to provide a quiet, uninterrupted work environment.
Must have a workstation that is not accessible to common traffic and is secure from unintentional access.
Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)

Required Qualifications

• Active, unrestricted pharmacist licensure in state of residence

• Board Certified Oncology Pharmacist (BCOP) required at time of hire, must currently hold this credential

• 2+ years clinical pharmacist experience, inclusive of prior authorization experience and/or oncology experience

• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.

• Must be able to multitask and utilize multiple system applications simultaneously.

• Must be able to utilize available resources independently and provide high quality work.

• Must demonstrate problem solving ability and attention to detail.

• Ability to adapt and change with workflow and shifting priorities.

• Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the PA team.

• Must possess excellent written, verbal, grammar, and listening communication skills.

• Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.

• Ability to maintain confidentiality of PHI (Protected Healthcare Information).

Education

BS in Pharmacy or PharmD required

Board Certified Oncology Pharmacist (BCOP) required

Active, unrestricted pharmacist licensure in state of residence required

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.