About City of Hope

City of Hope is an independent biomedical research and treatment organization for cancer, diabetes and other life-threatening diseases.

Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope™, a subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope’s specialized cancer expertise.

A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation’s “Best Hospitals” in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California and in Arizona.

City of Hope’s commitment to Diversity, Equity and Inclusion

We believe diversity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds and experiences to our work -- and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces diversity - in ideas, backgrounds and perspectives; this is reflected in our work and represented in our people.

Position Summary

The clinical authorization pharmacist is a licensed pharmacist who utilize their clinical oncology training to support non-pharmacy stakeholders such as Financial Clearance and Revenue Cycle to ensure medical benefits claim for infusion services are approved by payers. The clinical authorization pharmacist will provide support to the Financial Clearance team to ensure complete and appropriate pre-authorization request are sent out to payers and mitigate the occurrence of rework needed and/or payor rejection. This role will also support Revenue Cycle team members to ensure denied claims are successfully appealed and preventable write-offs are mitigated. Additionally, clinical authorization pharmacist will work with the pharmacy leadership team to develop novel or streamline current processes aimed at achieving optimal COH and payor formulary adherence, clinical pathway adherence, and other opportunities as identified by pharmacy leadership.

Key Responsibilities include:

Financial Clearance support:

• Collaborates with Financial Clearance team members, providers, nurses, clinical pharmacists andother 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, orsimilar payor platforms.
• Review treatment plan orders to ensure adequate medical necessity documentation, payorformulary adherence, COH formulary adherence, and optimal supportive care medicationutilization.
• 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 authorizationdenial appeals as necessary.
• Focus on mitigating preventable write-offs downstream.

Revenue Cycle support:

• Review claims denial report and support appeal efforts.
• Use evidence-based clinical justification to draft claims denial appeals as necessary.

Administrative support:

• Collaborate with pharmacy leadership to evaluate, develop, implement and maintain new COHformulary opportunities.
• Work collaboratively with clinical pharmacists throughout the network to operationalize implementation of said new formulary opportunities.

Education and Mentoring:

• 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 Models professional behavior to orient, mentor, and train new clinical staff as directed.

Other Responsibilities:

• Demonstrates ability to work as a member of the team by exhibiting good interpersonal skills andremaining flexible and open minded Mentors new staff and consistently models service excellence.
• Obtains and maintains licenses and certificates required for job function and completes all assigned trainings in a timely manner.
• Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality.
• Promotes collaboration and teamwork among all members of the healthcare team.
• 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.

Basic education, experience and skills required for consideration:

• 1 year of clinical oncology pharmacy experience or equivalent
• Current CA Pharmacist License

Preferred Education:

• Pharm D preferred

Preferred Courses/Training:

• ASHP Accredited Residency

Pref. Certification/Licensure:

• Board Certification in Oncology
• Board Certification in Pharmacotherapy

Preferred Experience:

• 1 or more years in pharmacy role that deals with medical authorizationand/or billing

Additional Information:

• As a condition of employment, City of Hope requires staff to comply with all state and federal vaccination mandates.
• Full Time
• Day Shift
• Multiple positions available
• Minimum hourly rate: $60.422115
• Maximum hourly rate: $100.904808