Job Description

Your Role

The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Principal Pharmacist, Oncology Drug Utilization Review, works as part of the pharmacy benefit PA team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics (P&T) Committee by ensuring that evidence-based clinical decisions are implemented appropriately to provide a high-quality, cost-effective pharmacy benefit, with a primary focus on oncology drug reviews. The Principal Pharmacist, Oncology Drug Utilization Review, reports to the Drug Utilization Review (DUR) Pharmacist Manager.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

This role offers a flexible and supportive work schedule designed to promote strong work-life balance. Standard hours are Monday through Friday during business hours, with flexible start times between 7:30 am and 9:00 am, typically ending between 4:30pm and 6:00 pm. The position also includes occasional weekend coverage (Saturday and Sunday), approximately once per month, with compensatory time off provided the following Monday and Tuesday.

Your Work

In this role, you will:

• Support the clinical and operational implementation of Pharmacy & Therapeutics (P&T)-approved policies for the pharmacy benefit across Commercial and Medicare lines of business
• Utilize a high-touch workflow to support oncology drug prior authorization reviews, including detailed clinical evaluation and provider engagement
• Apply advanced clinical expertise to prior authorization reviews and collaborate with PA and Call Center teams to support timely access to safe, effective, and medically necessary medications
• Ensure compliance with all regulatory, accreditation, and corporate requirements, including adherence to established turnaround times for review completion
• Serve as a clinical resource to internal and external stakeholders regarding the Blue Shield drug formulary, medication policies, and appropriate drug utilization
• Demonstrate Blue Shield values by contributing to team discussions, supporting colleagues, and responding to clinical and operational inquiries in a professional and collaborative manner
• Communicate clearly and effectively using concise, on-brand messaging when interacting with providers, members, and internal teams
• Adhere to all corporate policies and procedures
• Assist in audit preparation, reporting activities, and other projects or initiatives as assigned

Your Knowledge and Experience

• Requires Doctor of Pharmacy (PharmD) degree
• Requires active Board Certification in Oncology Pharmacy (BCOP)
• Requires active and unrestricted California Registered Pharmacist (RPh) license
• Requires at least 4 years of experience in clinical pharmacy
• Thorough knowledge of oncology therapeutics and evidence-based treatment guidelines required
• Excellent communication skills with the ability to engage both clinical and non-clinical audiences

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business needs.

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