Utilization Management Pharmacist, Oncology

This is a fully remote position, open to applicants in California.

📋 Description

• Assist in the development, execution, and continual enhancement of oncology utilization management processes.

• Evaluate oncology medication requests and clinical documentation to ensure compliance with NCCN guidelines, payer policies, formulary standards, and internal pathway criteria.

• Facilitate prior authorization and utilization management workflows by elucidating clinical rationale and pinpointing documentation deficiencies.

• Convert clinical criteria into pathways, checklists, portals, and review logic for oncology medications.

• Collaborate with Revenue Cycle Management, Informatics, Medical Oncology leadership, and UM Compliance to synchronize EHR builds, portal criteria, payer requirements, and internal processes.

• Keep track of updates to NCCN, ASCO, FDA indications, payer policies, compendia, and utilization management standards.

• Address complex or non-standard cases with recommendations and supporting evidence.

• Engage in process improvement initiatives, audits, and quality monitoring activities.

• Execute agreed-upon therapeutic and supportive-care medication modifications within TOI Clinics.

• Promote internal education and continuous enhancement regarding medication utilization, preferred therapies, biosimilars, and payer-aligned criteria.

⛳️ Requirements

• Doctor of Pharmacy (PharmD) from an ACPE-accredited School of Pharmacy.

• Active pharmacist license in good standing.

• Experience in oncology pharmacy within a clinical, managed care, utilization management, specialty pharmacy, or similar environment.

• Proficiency in interpreting payer medical policies, prior authorization criteria, NCCN compendia, and oncology treatment guidelines.

• Solid understanding of chemotherapy, immunotherapy, targeted therapies, biosimilars, and supportive care agents.

• Capability to translate clinical guidelines and payer criteria into review workflows, pathway logic, checklists, and documentation standards.

• Excellent written communication skills for summarizing evidence, criteria, and recommendations.

• Familiarity with EHRs, UM portals, payer policy resources, drug databases, spreadsheets, and reporting tools.

• Ability to analyze utilization patterns, identify workflow gaps, and suggest improvements.

• Preferred: board certification in oncology pharmacy, such as BCOP, or equivalent oncology expertise.

• Preferred: previous experience in utilization management, managed care, oncology pathways, payer criteria review, or value-based care initiatives.

• Ability to balance clinical appropriateness, payer requirements, provider experience, operational efficiency, and patient access considerations.

• Ability to engage in prolonged desk sitting, extensive computer use, and phone or virtual meeting interactions; occasional lifting of up to 20 pounds may be necessary.

🏝️ Benefits

• Comprehensive health and wellness benefits.

• Opportunities for professional growth and development.

• Collaborative work environment with a focus on team support.

• Competitive salary and compensation packages.