Clinical Authorization Oncology Pharmacist

Job Description

Job Description

Description:

POSITION SUMMARY:

The Clinical Authorization Pharmacist is a licensed professional with specialized oncology training who collaborates with non-pharmacy teams, including Prior Authorization, Financial Assistance and Revenue Cycle, to secure payer approval for Oral Chemotherapy, Clear Bagging, and infusion service claims. This role supports the Financial Clearance team by ensuring that pre-authorization requests are accurate and complete, minimizing the need for rework or reducing the risk of payer rejections. Additionally, the Clinical Authorization Pharmacist assists the Revenue Cycle and Pharmacy team in successfully appealing denied claims, reviewing insurance audits, and preventing unnecessary write-offs. They also work closely on our Medically Integrated Dispensing and Infusion pharmacy leadership to support different pharmacists’ roles and facilitate communication between clinical and non-clinical teams

CORE ESSENTIAL RESPONSIBILITIES:

• Provides clinical justification and participates in peer-to-peer reviews for medical and pharmacy denial appeals.
• Ensures therapy plans reflect actual treatment (e.g., biosimilar changes, patient-supplied meds).
• Oversees accreditation and ensures compliance with required standards.
• Conducts quality assurance on authorization requests, including billable units, diagnosis codes, and non-covered services.
• Works to prevent write-offs and reduce risk of reimbursement audits.
• Collaborates with Financial Clearance, providers, nurses, and clinical staff to ensure appropriate authorization requests.
• Verifies medical necessity and documentation for treatment plans.
• Reviews payer portals (e.g., AIM, Evicore) to ensure adherence to guidelines.
• Aids Infusion and MID leadership in maximizing revenue and enterprise value.
• Reviews denials and supports appeals process.
• Assists Specialty Pharmacy with test claims and benefit analysis.
• Supports infusion pharmacists with prescription transcription and routing.
• Offers drug information and education to providers.

EDUCATION & EXPERIENCE

• Doctor of Pharmacy (PharmD) degree from an accredited college of pharmacy required.
• Completion of a Pharmacy Practice Residency or Board Certification in Oncology Pharmacy (BCOP) preferred.
• Minimum of 1 year of Pharmacy experience in a Specialty Pharmacy, Oncology Practice, Insurance Company or a Pharmacy Benefit Management Company

CERTIFICATES, LICENSE OR REGISTRATION

• Florida Registered Pharmacist License required.