Payer Strategy Jobs in Boca Raton, FL (NOW HIRING)

POSITION SUMMARY:

The Clinical Oncology Pharmacist – Medication Access Services is a licensed oncology pharmacist responsible for supporting the clinical, operational, and financial integrity of oncology medication management across the enterprise. This role serves as a clinical liaison between providers, infusion operations, specialty pharmacy, financial clearance, revenue cycle, and payer organizations to support timely patient access to medically necessary oncology therapies.

The pharmacist provides clinical oversight of oncology treatment plans, ensures alignment with evidence-based guidelines and payer medical necessity criteria, supports prior authorization and appeal processes, and collaborates with multidisciplinary teams to optimize reimbursement outcomes while maintaining the highest standards of patient safety and regulatory compliance.

This role’s main focus is to support medically integrated dispensing (MID) pharmacy operations and contributes to initiatives focused on denial prevention, treatment optimization, payer strategy, accreditation readiness, and medication access improvement.

CORE ESSENTIAL RESPONSIBILITIES:

• Review and evaluate oncology treatment plans and medication regimens for clinical appropriateness, evidence-based compliance, and alignment with payer medical necessity criteria utilizing NCCN and other nationally recognized oncology guidelines.
• Collaborate with providers, nurses, financial clearance specialists, specialty pharmacy personnel, and revenue cycle teams to support timely patient access to oncology therapies and reduce delays in treatment initiation.
• Provide clinical oversight and quality assurance review of prior authorization submissions, including diagnosis code alignment, billable units, payer-specific requirements, and supporting medical necessity documentation.
• Participate in payer peer-to-peer discussions, authorization denial appeals, audit responses, and reimbursement recovery efforts utilizing evidence-based clinical justification.
• Support denial prevention initiatives by identifying authorization gaps, non-covered services, payer policy inconsistencies, and documentation deficiencies that may impact reimbursement outcomes.
• Provide clinical guidance regarding chemotherapy, immunotherapy, targeted therapies, supportive care agents, biosimilars, oral oncolytic, and specialty medications to providers, nurses, pharmacy technicians, and operational teams.
• Support medically integrated dispensing and infusion pharmacy operations through treatment plan integrity review, formulary optimization, white bagging coordination, biosimilar management, and payer-directed product selection when clinically appropriate.
• Provide operational and clinical cross-coverage support for infusion, specialty pharmacy, and medication access services as needed, including, urgent clinical issues, workflow disruptions, or direct requests from providers and clinical staff.
• Serve as a clinical resource to infusion and medically integrated dispensing pharmacy technicians by providing guidance, direction, and operational support.
• Participate in accreditation, medication safety, quality assurance, workflow optimization, and regulatory compliance initiatives related to USP 797, USP 800, ACHC, and applicable state and federal standards while maintaining accurate documentation within the electronic health record and associated pharmacy systems.

REQUIRED EDUCATION & EXPERIENCE:

• Doctor of Pharmacy (PharmD) degree from an accredited college of pharmacy required.
• Completion of a Pharmacy Practice Residency or Board Certification in Oncology Pharmacy (BCOP) preferred.
• Minimum of 3–5 years of oncology pharmacy experience in an ambulatory oncology practice, infusion center, specialty pharmacy, health system, payer organization, or related oncology setting preferred.
• Experience with oncology prior authorizations, payer appeals, specialty pharmacy workflows, reimbursement strategy, or revenue cycle operations strongly preferred.

REQUIRED CERTIFICATES, LICENSE OR REGISTRATION:

• Florida Registered Pharmacist License required.

REQUIRED KNOWLEDGE, SKILLS OR ABILITIES:

• In-depth knowledge of oncology pharmacotherapy, including chemotherapy, immunotherapy, and supportive care regimens.
• Strong understanding of regulatory standards (e.g., USP 797, USP 800, ACHC), medication safety, and evidence-based treatment guidelines (e.g., NCCN).
• Proficiency with electronic health records (EHR), pharmacy dispensing systems, and inventory management tools.