Utilization Management Pharmacist, Oncology

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🔥 7 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $144k - $170k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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The Oncology Institute

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

💊 Pharmaceuticals

🧘 Wellness

💰 Post-IPO Equity on 2021-11

Healthcare • Pharmaceuticals • Wellness

The Oncology Institute is a healthcare organization founded in 2007 that specializes in delivering value-based cancer care and advancing oncology through innovative practices. With over 90 employed clinicians and a team of more than 700 personnel across 50 clinic locations, The Oncology Institute offers a range of services including chemotherapy, clinical trials, and cancer prevention to a population of over 1. 7 million patients. Its commitment to evidence-based, compassionate care is aimed at healing and empowering cancer patients in community settings.

📋 Description

• Review oncology medication requests and clinical documentation against NCCN guidelines, TOI standards, payer medical policies, and formulary or pathway criteria • Support prior authorization and utilization management workflows by clarifying clinical rationale and documentation gaps • Translate clinical criteria into pathway, checklist, and portal logic for oncology and supportive care medications • Partner with Revenue Cycle Management, Informatics, Medical Oncology leadership, and UM Compliance to align EHR builds, portal criteria, payer requirements, and internal processes • Monitor updates to NCCN, ASCO, FDA indications, payer policies, compendia, and utilization management requirements • Escalate complex or non-standard cases with recommendations and supporting evidence • Participate in process improvement initiatives, audits, and quality monitoring related to medication utilization management and pathway compliance • Implement agreed therapeutic and supportive care medication use changes within TOI Clinics

🎯 Requirements

• Doctor of Pharmacy (PharmD) from an ACPE-accredited School of Pharmacy • Active pharmacist license in good standing • Oncology pharmacy experience in a clinical, managed care, utilization management, specialty pharmacy, or related setting • Experience interpreting payer medical policies, prior authorization criteria, NCCN compendia, and oncology treatment guidelines • Strong knowledge of oncology therapeutics, including chemotherapy, immunotherapy, targeted therapies, biosimilars, and supportive care agents • Ability to convert clinical guidelines and payer criteria into review workflows, pathway logic, checklists, and documentation standards • Strong written communication skills for summarizing evidence, criteria, and recommendations • Comfort working with EHRs, UM portals, payer policy resources, drug databases, spreadsheets, and reporting tools • Ability to analyze utilization patterns, identify workflow gaps, and recommend improvements

🏖️ Benefits

• Remote work from home • Reasonable accommodation may be made for individuals with disabilities • Salaried compensation with a typical wage range of $144,000–$170,000 USD