Patient Access and Appeals Pharmacist

Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center in Washington.

With a track record of global leadership in bone marrow transplantation, HIV/AIDS prevention, immunotherapy and COVID-19 vaccines, Fred Hutch has earned a reputation as one of the world's leading cancer, infectious disease and biomedical research centers. Fred Hutch operates eight clinical care sites that provide medical oncology, infusion, radiation, proton therapy and related services, and network affiliations with hospitals in five states. Together, our fully integrated research and clinical care teams seek to discover new cures to the world's deadliest diseases and make life beyond cancer a reality.

At Fred Hutch we value collaboration, compassion, determination, excellence, innovation, integrity and respect. Our mission is directly tied to the humanity, dignity and inherent value of each employee, patient, community member and supporter. Our commitment to learning across our differences and similarities make us stronger. We seek employees who bring different and innovative ways of seeing the world and solving problems.

Responsible for the clinical evaluation, justification, and coordination of complex pharmacy coverage determinations for oncology and supportive care therapies across Fred Hutch pharmacies (retail and clinic-administered). Interpret clinical guidelines, FDA labeling, recognized compendia, and payer policies to develop evidence-based coverage strategies, leads off-label use assessments, and prepare clinically substantiated appeals to optimize timely patient access while ensuring regulatory compliance.

Note: This role does not perform routine prior authorization data entry or submission. It provides clinical expertise, escalation support, and coverage determinations that complement the PA technicians and revenue cycle workflows.

Perform patient-specific clinical reviews (diagnosis, regimen, dosing, monitoring parameters) against FDA labeling, NCCN and other recognized compendia, payer policies, and CMS rules to determine coverage pathways and document clinical necessity.
• Prepare cases, synthesize evidence, present recommendations, and facilitate FHCC Off Label Steering Committee activities (patient-specific reviews, quarterly meetings), ensuring documentation and policy alignment.
• Draft clinically substantiated LMNs and appeal packets with guideline citations, comparative efficacy/safety, and therapeutic alternatives. Conduct clinical discussions with payer pharmacists/medical directors and coordinate provider-led peer to peer reviews when required.
• Determine onlabel/compendia-supported coverage and compliance with CMS/NCD/LCD criteria; advise providers and clinical pharmacists on coverage constraints, alternatives, or sequencing to maintain regulatory compliance.
• Trend denials, identify clinical documentation gaps or policy misalignment, and lead education and workflow refinements with providers, clinic teams, and PA staff to reduce avoidable denials.
• Monitor and interpret payer policy updates; translate changes into clear clinical guidance and standard work for authorization and clinic teams; maintain decision support content (tip sheets, pathways).
• Partner with revenue cycle, infusion operations, and care teams to navigate payer site-of-care requirements (e.g., hospital outpatient vs. alternate sites), balancing clinical appropriateness, access, and cost.
• Streamline supportive care and other therapy workflows; serve as a clinical resource for regimen selection and coverage strategy to reduce provider and clinical pharmacist burden on access tasks.
• Ensure accurate clinical documentation, adherence to institutional policies and regulatory standards; support internal/external audits related to coverage determination.
• Provide backup coverage for the Pharmacy Patient Access & Authorization function (OOO/leave) to maintain uninterrupted clinical access support.
• Other duties as assigned.

Required:

• Doctor of pharmacy (PharmD) degree, or equivalent, from an accredited School of Pharmacy
• 5 years of experience as a pharmacist
• State of Washington Pharmacist License
• Competency in oncology pharmacotherapy and evidence appraisal; ability to interpret and apply NCCN/ASCO guidelines, FDA labeling, and recognized compendia in coverage determinations.
• Understanding of payer policy constructs (medical vs. pharmacy benefit), formulary management, step therapy, prior authorization criteria, medical necessity standards, and site-of-care policies.
• Familiarity with CMS coverage concepts (NCD/LCD), conditions of payment, and documentation standards for oncology therapies.
• Ability to craft persuasive, clinical appeals and LMNs with clear rationale, citations, and therapeutic alternatives.
• Skilled in clinical communication with providers, nurses, pharmacists, and payer clinical teams; strong presentation and stakeholder engagement skills.
• Proficient in data trending and root cause analysis for denials; intermediate Excel and report-building skills.
• Proficient user of Microsoft Office (Word, Excel, PowerPoint, Visio) and EHR decision support tools (e.g., order sets, pathways).

Preferred:

• Experience with Epic/Beacon or similar oncology EHR modules and payer portals.
• 1-3 years in oncology practice and/or clinical prior authorization/coverage determination work.
• Experience developing policy summaries, tip sheets, or clinical decision support for access workflows.

Pre-Employment Drug Screening:
As a condition of employment Fred Hutch conducts pre-employment drug testing for this pharmacy role. All offers of employment in the pharmacy department are conditional on the applicant successfully completing and passing a drug test in accordance with the Fred Hutch policy.

The annual base salary range for this position is from $156,832.00 to $261,352.00, and pay offered will be based on experience and qualifications.

This position is not eligible for H-1B sponsorship at this time.

This role will have the opportunity to work partially at our campus and remotely.

Fred Hutchinson Cancer Center offers employees a comprehensive benefits package designed to enhance health, well-being, and financial security. Benefits include medical/vision, dental, flexible spending accounts, life, disability, retirement, family life support, employee assistance program, onsite health clinic, tuition reimbursement, paid vacation (12-22 days per year), paid sick leave (12-25 days per year), paid holidays (13 days per year), paid parental leave (up to 4 weeks).