Utilization Management Pharmacist, OncologyNew Cerritos, California, United States

The Oncology Institute (TOI), founded in 2007 and publicly traded on NASDAQ, advances oncology by delivering highly specialized, value-based cancer care in the community setting. TOI provides cutting-edge, evidence-based cancer care—including clinical trials and transfusions—to approximately 1.9 million patients across over 100 clinics in five states. Utilization Management Pharmacists at TOI are clinical leaders who ensure safe, effective, and compassionate cancer care by shaping evidence-based treatment pathways, optimizing therapies, and driving innovation to improve outcomes and reduce patient barriers.

About the role

The Utilization Management Pharmacist supports the development, implementation, and ongoing optimization of oncology utilization management processes. This role applies clinical pharmacy expertise, evidence-based guidelines, payer policy knowledge, and formulary standards to promote appropriate therapy selection, reduce avoidable prior authorization friction, and support value-based oncology care. The pharmacist partners with pharmacy leadership, physicians, advanced practice providers, revenue cycle management, informatics, and utilization management compliance teams to align medication review processes, pathway logic, evidence requirements, and operational workflows.

Responsibilities

• Review oncology medication requests and related 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 helping reduce avoidable delays in therapy access.
• Translate clinical criteria into clear pathway, checklist, or portal logic that supports consistent review of chemotherapy, immunotherapy, targeted therapy, biosimilars, supportive care medications, and other oncology agents.
• Partner with Revenue Cycle Management, Informatics, Medical Oncology leadership, and UM Compliance to keep EHR builds, UM portal criteria, payer requirements, and internal processes aligned.
• Maintain awareness of updates to NCCN, ASCO, FDA indications, payer medical policies, compendia, and state or federal utilization management requirements that may affect oncology medication review.
• Escalate clinically complex or non-standard cases to utilization management leadership and appropriate clinical stakeholders with clear recommendations and supporting evidence.
• Participate in process improvement initiatives, audits, and quality monitoring activities related to medication utilization management, documentation completeness, and pathway compliance.
• Implement mutually agreed upon therapeutic and supportive care medication use changes within the patient care setting for 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, checklists, and clear documentation standards.
• Strong written communication skills with the ability to summarize evidence, criteria, and recommendations for clinical and operational audiences.
• 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 actionable improvements.

Preferred Attributes

• Board certification in oncology pharmacy, such as BCOP, or demonstrated equivalent oncology expertise.
• Prior experience in utilization management, managed care, oncology pathways, payer criteria review, or value-based care initiatives.
• Collaborative, detail-oriented, and comfortable working in an evolving environment where workflows, standards, and digital tools continue to mature.
• Ability to balance clinical appropriateness, payer requirements, provider experience, operational efficiency, and patient access considerations.

Physical Working Requirements

The position involves prolonged periods of sitting at a desk, extensive computer use, and phone or virtual meeting interaction. The role may require occasional lifting of up to 20 pounds for office supplies or equipment. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Pay

$144,000 - $170,000 USD