Pharmacist, Principal - Oncology - BCOP- Prior Authorization

Principal Pharmacist, Oncology Drug Utilization Review

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.

Responsibilities

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

Qualifications

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.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.