Utilization Management Pharmacist, Oncology

The Oncology Institute (NASDAQ: TOI), founded in 2007, advances oncology by delivering highly specialized, value-based cancer care in the community setting. With over 180 clinicians and 100+ clinics across five states, TOI provides cutting-edge, evidence-based cancer care—including clinical trials and transfusions—to approximately 1.9 million patients.

About the role

As a Utilization Management Pharmacist, you will serve as a clinical leader ensuring safe, effective, and compassionate cancer care. You’ll shape evidence-based treatment pathways, optimize therapies, and drive innovation to improve patient outcomes and reduce barriers to access.

Responsibilities

• Review oncology medication requests and clinical documentation for alignment with NCCN guidelines, TOI standards, payer medical policies, and internal formulary or pathway criteria.
• Support prior authorization and utilization management workflows by clarifying clinical rationale, identifying documentation gaps, and reducing avoidable delays in therapy access.
• Translate clinical criteria into clear pathway, checklist, or portal logic for consistent review of chemotherapy, immunotherapy, targeted therapy, biosimilars, and supportive care medications.
• Partner with Revenue Cycle Management, Informatics, Medical Oncology leadership, and UM Compliance to align EHR builds, UM portal criteria, payer requirements, and internal processes.
• Maintain awareness of updates to NCCN, ASCO, FDA indications, payer medical policies, compendia, and state/federal utilization management requirements.
• Escalate clinically complex or non-standard cases to leadership with clear recommendations and supporting evidence.
• Participate in process improvement initiatives, audits, and quality monitoring related to medication utilization management and pathway compliance.
• Implement 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.

Skills

• Strong knowledge of oncology therapeutics, including chemotherapy, immunotherapy, targeted therapies, biosimilars, and supportive care agents.
• Ability to convert clinical guidelines and payer criteria into practical review workflows, pathway logic, and documentation standards.
• Excellent written communication skills for summarizing evidence and recommendations for clinical and operational audiences.
• Comfort working with EHRs, UM portals, payer policy resources, drug databases, spreadsheets, and reporting tools.
• Analytical skills to identify utilization patterns, workflow gaps, and recommend improvements.

Preferred Attributes

• Board certification in oncology pharmacy (BCOP) or equivalent expertise.
• Prior experience in utilization management, managed care, oncology pathways, payer criteria review, or value-based care initiatives.
• Collaborative, detail-oriented, and adaptable in evolving environments with maturing workflows and digital tools.
• Ability to balance clinical appropriateness, payer requirements, provider experience, operational efficiency, and patient access.

Physical Working Requirements

• Prolonged periods of sitting at a desk and extensive computer use.
• Occasional lifting of up to 20 pounds for office supplies or equipment.
• Reasonable accommodations may be made for individuals with disabilities.

Pay

$144,000—$170,000 USD (salaried). The displayed range represents the typical wage for candidates hired; actual salary may vary based on skills, experience, and comparison to existing employees in the role.