Utilization Management Pharmacist, Oncology

This role offers an opportunity to apply advanced pharmacy expertise to the delivery of safe, evidence-based oncology care. You will help shape utilization management processes that promote appropriate treatment while reducing unnecessary barriers to patient access.

About the role

Working across clinical, pharmacy, revenue cycle, informatics, and compliance teams, you will help align medication review with clinical and payer requirements. You will translate complex oncology guidelines and policies into practical workflows, pathways, and documentation standards. The position combines clinical decision-making, utilization analysis, process improvement, and cross-functional collaboration. You will also contribute to initiatives involving preferred therapies, biosimilars, supportive care, and value-based oncology practices.

Responsibilities

• Review oncology medication requests and supporting clinical documentation against NCCN guidelines, internal standards, payer medical policies, formularies, and treatment pathway criteria.
• Support prior authorization and utilization management workflows by evaluating clinical rationale, identifying documentation gaps, and helping reduce avoidable delays in treatment access.
• Translate clinical guidelines, payer requirements, and evidence into practical pathway logic, checklists, review criteria, and documentation standards for chemotherapy, immunotherapy, targeted therapies, biosimilars, supportive care, and other oncology medications.
• Partner with Revenue Cycle Management, Informatics, Medical Oncology leadership, and utilization management compliance teams to align EHR configurations, utilization management portal criteria, payer requirements, and operational workflows.
• Monitor updates to NCCN and ASCO guidance, FDA indications, payer policies, compendia, and state or federal utilization management requirements that may affect medication reviews.
• Escalate clinically complex, non-standard, or high-risk cases to appropriate clinical and utilization management leaders with clear recommendations and supporting evidence.
• Participate in process improvement initiatives, audits, and quality monitoring activities related to medication utilization, documentation quality, pathway adherence, and review consistency.
• Analyze utilization patterns and operational workflows to identify gaps, inefficiencies, and opportunities for improvement.
• Support the implementation of agreed-upon therapeutic and supportive medication use changes within clinical care settings.
• Provide clinical education and guidance to internal stakeholders regarding medication utilization, preferred therapies, biosimilars, payer criteria, and evidence-based oncology practices.

Requirements

• Doctor of Pharmacy (PharmD) degree from an ACPE-accredited School of Pharmacy.
• Active and unrestricted pharmacist license in good standing.
• Professional oncology pharmacy experience in a clinical, managed care, utilization management, specialty pharmacy, or related environment.
• Experience interpreting payer medical policies, prior authorization requirements, NCCN compendia, and oncology treatment guidelines.
• Strong knowledge of oncology therapeutics, including chemotherapy, immunotherapy, targeted therapies, biosimilars, and supportive care medications.
• Ability to translate complex clinical guidelines and payer criteria into practical review workflows, pathway logic, checklists, and documentation requirements.
• Strong written communication skills, with the ability to clearly summarize clinical evidence, review criteria, and recommendations for both clinical and operational audiences.
• Comfortable working with EHR systems, utilization management portals, payer policy resources, drug databases, spreadsheets, and reporting tools.
• Ability to analyze medication utilization and workflow data, identify operational gaps, and recommend actionable improvements.
• Strong attention to detail, clinical judgment, collaboration, and organizational skills.
• Ability to balance clinical appropriateness, payer requirements, provider experience, operational efficiency, and patient access considerations.
• Board certification in oncology pharmacy, such as BCOP, is preferred, as is experience with utilization management, managed care, oncology pathways, payer criteria review, or value-based care initiatives.
• Comfortable working in an evolving environment where clinical standards, workflows, and digital tools continue to develop.

Benefits

• Fully remote, work-from-home position.
• Opportunity to contribute directly to evidence-based oncology care and improved patient access to appropriate therapies.
• High-impact collaboration with pharmacy, medical, informatics, revenue cycle, and compliance professionals.
• Opportunity to influence utilization management strategy, oncology pathways, and medication review processes.
• Professional environment focused on continuous improvement, clinical quality, and value-based care.
• Reasonable workplace accommodations available for qualified individuals with disabilities.

Pay

Salary range of $144,000-$170,000 USD, with actual compensation determined by factors including skills, experience, and internal equity.