REMOTE Utilization Management Pharmacist, Oncology
About The Position
Starling Oncology is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. The Utilization Management Pharmacist supports the development, implementation, and ongoing optimization of oncology utilization management processes. This role applies clinical pharmacy expertise, evidence-based guidelines, payer policy knowledge, and formulary standards to promote appropriate therapy selection, reduce avoidable prior authorization friction, and support value-based oncology care. The pharmacist partners with pharmacy leadership, physicians, advanced practice providers, revenue cycle management, informatics, and utilization management compliance teams to align medication review processes, pathway logic, evidence requirements, and operational workflows. The role also supports internal education and continuous improvement efforts related to medication utilization, preferred therapies, biosimilars, and payer-aligned criteria.
Requirements
- Doctor of Pharmacy (PharmD) from an ACPE-accredited School of Pharmacy.
- Active pharmacist license in good standing.
- Oncology pharmacy experience in a clinical, managed care, utilization management, specialty pharmacy, or related setting.
- Experience interpreting payer medical policies, prior authorization criteria, NCCN compendia, and oncology treatment guidelines.
- Strong knowledge of oncology therapeutics, including chemotherapy, immunotherapy, targeted therapies, biosimilars, and supportive care agents.
- Ability to convert clinical guidelines and payer criteria into practical review workflows, pathway logic, checklists, and clear documentation standards.
- Strong written communication skills with the ability to summarize evidence, criteria, and recommendations for clinical and operational audiences.
- Comfort working with EHRs, UM portals, payer policy resources, drug databases, spreadsheets, and reporting tools.
- Ability to analyze utilization patterns, identify workflow gaps, and recommend actionable improvements.
Nice To Haves
- Board certification in oncology pharmacy, such as BCOP, or demonstrated equivalent oncology expertise.
- Prior experience in utilization management, managed care, oncology pathways, payer criteria review, or value-based care initiatives.
- Collaborative, detail-oriented, and comfortable working in an evolving environment where workflows, standards, and digital tools continue to mature.
- Ability to balance clinical appropriateness, payer requirements, provider experience, operational efficiency, and patient access considerations.
Responsibilities
- Review oncology medication requests and related clinical documentation for alignment with NCCN guidelines, TOI standards, payer medical policies, and internal formulary or pathway criteria.
- Support prior authorization and utilization management workflows by clarifying clinical rationale, identifying documentation gaps, and helping to reduce avoidable delays in therapy access.
- Translate clinical criteria into clear pathway, checklist, or portal logic that supports consistent review of chemotherapy, immunotherapy, targeted therapy, biosimilars, supportive care medications, and other oncology agents.
- Partner with Revenue Cycle Management, Informatics, Medical Oncology leadership, and UM Compliance to keep EHR builds, UM portal criteria, payer requirements, and internal processes aligned.
- Maintain awareness of updates to NCCN, ASCO, FDA indications, payer medical policies, compendia, and state or federal utilization management requirements that may affect oncology medication review.
- Escalate clinically complex or non-standard cases to utilization management leadership and appropriate clinical stakeholders with clear recommendations and supporting evidence.
- Participate in process improvement initiatives, audits, and quality monitoring activities related to medication utilization management, documentation completeness, and pathway compliance.
- Implement mutually agreed upon therapeutic and supportive care medication use changes within the patient care setting for TOI Clinics.
Benefits
- Pay Transparency for salaried teammates
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
