Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

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POSITION SUMMARY: As an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. In addition, as an Oncology Pharmacist you will assist front-line colleagues (i.e. Staff Pharmacists and Representatives) with oncology process/procedural support by acting as a subject matter expert 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, continuing education and certification. This position also supports departmental leadership in identifying issues, concerns and trends within the workflow process. The Pharmacist will partner with our Lead Oncology Pharmacist to help develop/deliver formal clinical training sessions, delivering them to staff to enhance their clinical knowledge base in relation to the oncology disease states and therapies. Strong effective communication is required to ensure the thorough distribution, understanding and execution of required knowledge transfer to internal and external stakeholders. The Pharmacist will be expected to work closely with other teams and departments throughout the company including Case Review Unit (CRU), Commercial PA & appeals, internal Medical Directors, Clinical Development, and our Client Liaison team. 

This is a work-from-home role open to qualified candidates within the United States. Candidate must be willing and able to work 9am-5:30pm EST M-F, with the ability to flex to later or earlier if needed for training, client meetings, or other business needs.

PRIMARY DUTIES AND RESPONSIBILITIES:  

1. Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design with a focus on oncology reviews. 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. 
% Time: 70%

2. A Leader in identifying and solving issues, concerns and trends within the workflow process that need to be addressed at a higher level resulting in optimal performance and outcomes. Responsible for assisting front-line colleagues (i.e. Staff Pharmacists 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.
% Time: 20%

3. Assist with standard or client specific oncology review process changes as needed. 
% Time: 5%

4. Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.
% Time: 5%

EDUCATION

BS in Pharmacy or PharmD

Required: Licensed Pharmacist and Board Certified Oncology Pharmacist (BCOP)


REQUIRED SKILLS & OTHER MINIMUM REQUIRED QUALIFICATIONS:  
• Active pharmacist license in the state of residence that is in good standing.

• Board Certified Oncology Pharmacist (BCOP) required

• 2+ years clinical pharmacist experience, inclusive of prior authorization experience

• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio