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Role Description

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 requests 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:

• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Collaborate with technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data.
• Assist front-line colleagues with oncology process/procedural support by acting as a subject matter expert (SME).
• Assist with standard or client specific oncology review process changes as needed.
• Assist with writing Work Instructions when needed.
• Work collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.
• Provide feedback of trends pertinent to oncology reviews.
• Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs.
• Perform other related projects and duties as assigned, including attending training sessions and development meetings.

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:

• Regular and predictable attendance.
• Colleague may be required to work mandatory overtime/extended work week when needed.
• Colleague may be required to travel when needed.
• Comply with departmental, company, state, and federal requirements when processing all information.
• Adhere to all policies and procedures.
• Attend ongoing training and development meetings as assigned.

Requirements

• Active, unrestricted pharmacist licensure in state of residence.
• Board Certified Oncology Pharmacist (BCOP) required at time of hire.
• 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.
• Must be able to multitask and utilize multiple system applications simultaneously.
• 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.
• 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.

Pay Range

The typical pay range for this role is: $45.43 - $101.54. 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.

Benefits

• Affordable medical plan options.
• 401(k) plan (including matching company contributions).
• 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.