OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, patients, and life science researchers navigate the physical, mental, and financial complexities of cancer through technology enabled services and real-world data analytics. Through an evidence-based, real-world analytics approach to utilization management, OncoHealth’s prior authorization platform is used by health plans and their network physicians to support 7 million health plan members in the US and Puerto Rico.
About the Role
The Clinical Pharmacist is responsible for facilitating the case review process for prior authorizations, building/maintaining protocols, providing recommendations on coverage determination, and constructing Recommendations for Adverse Determination (RADs). This position requires the ability to analyze evidence-based medicine resources, as well as those for coverage determination, to evaluate whether therapy requested for prior authorization is supported for coverage and is best suited for the given situation. It will also support the operations of new products and services.
- You will participate in case reviews and serve as initial clinical reviewer or provide secondary input for authorization process
- Draft Recommendations for Adverse Determination (RAD’s) for review by Medical Director(s)
- Synthesize treatment opinions supported by evidence-based medicine
- Maintain accurate records of all interventions and communications and provide timely verbal/written assessments on each case reviewed
- Department project participation as determined by the department's needs i.e. training for new hires/students/other departments, clinical information updates, creation and review of clinical policies, and client support
- Doctorate in Pharmacy (PharmD) or relevant experience required
- Minimum of 2 years of experience in the clinical oncology setting, managed care, or relevant educational attainment required
- Must be proficient in evaluating oncology drug treatment decision and recommending alternative therapy where appropriate and possess ability to interpret primary scientific literature
- MS Office Suite proficiency
About the Location
We are open to remote work preferably in the Pacific or Mountain time zones to cover 12pm-8pm ET shift.
Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!
We offer a full benefits packaging on your first day, along with a company bonus and equity so you can experience the value of our growth along with the rest of the team. You will work from (or visit) our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 200 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by leading healthcare equity partners, we remain in an investment mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!
Our Current Solutions
Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.
OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.
OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.