Clinical Authorization Pharmacist

Clinical Authorization Pharmacist

Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, andtreatment facilitiesin Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

The Clinical Authorization Pharmacist is a licensed professional with specialized oncology training who collaborates with non-pharmacy teams, including Financial Clearance and Revenue Cycle, to secure payer approval for infusion service claims. This role supports the Financial Clearance team by ensuring that pre-authorization requests are accurate and complete, minimizing the need for rework or reducing the risk of payer rejections. Additionally, the Clinical Authorization Pharmacist assists the Revenue Cycle team in successfully appealing denied claims and preventing unnecessary write-offs. They also work closely with pharmacy leadership to develop and refine processes that enhance adherence to COH and payer formularies, clinical pathways, and other key initiatives identified by leadership.

As a successful candidate, you will:

• Collaborates with Financial Clearance team members, providers, nurses, clinical pharmacists and other clinical staff to ensure authorization requests are appropriate prior to submission to payers.
• Ensure payor guideline adherence by careful review of payor portals such as AIM, Evicore, or similar payor platforms.
• Review treatment plan orders to ensure adequate medical necessity documentation, payor formulary adherence, COH formulary adherence, and optimal supportive care medication utilization.
• Provide quality assurance review of authorization requests to ensure billable units, formulation, diagnosis code alignment are appropriate, and flag non-covered services.
• Use evidence based clinical justification to participate in peer-to-peer review for authorization denial appeals as necessary.
• Focus on mitigating preventable write-offs downstream.
• Review claims denial report and support appeal efforts.
• Provides drug information and education to health care providers as needed.
• Actively participates in the education and development of pharmacists, pharmacy residents and pharmacy students as directed.
• Maintains patient confidentiality in accordance with City of Hope standards.
• Maintains compliance with all rules and regulations governing the practice of Pharmacy and City of Hope policies and procedures.
• Performs other duties as assigned by the Leadership Team.

Your qualifications should include:

• Graduate of ACPE-accredited Pharmacy School or School with ACPE accreditation pending
• 1 year of clinical oncology pharmacy experience or equivalent
• ASHP Accredited Residency - preferred
• Current CA Pharmacist License
• American Heart Association BLS certification
• 1 or more years in pharmacy role that deals with medical authorization and/or billing, preferred

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity and inclusion, please click here.