Clinical Pharmacist – Prior Authorization/Oncology; BCOP
Job in
Oregon, Dane County, Wisconsin, 53575, USA
Listing for:
CVS Health
Full Time
position
Listed on 2026-03-09
Job specializations:
-
Healthcare
Healthcare Compliance
Salary/Wage Range or Industry Benchmark: 80000 - 100000 USD Yearly
USD
80000.00
100000.00
YEAR
Job Description & How to Apply Below
Position: 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
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.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.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.Assist with standard or client specific oncology review process changes as needed.Assist with writing Work Instructions when needed.Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.Provide feedback of trends pertinent to oncology reviews.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.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…
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