Chapel Hill, NC11 days ago
Review high-cost specialty and infusion drug requests — including biologics, biosimilars, CAR-T cell therapies, bispecific antibodies, antibody-drug conjugates, and other oncology agents — applying appropriate step therapy, biosimilar preference, and site-of-care criteria. Review oncology cases and make coverage and medical necessity determinations for chemotherapy, immunotherapy, targeted therapy, hormonal therapy, and supportive care regimens using NCCN Guidelines, MCG, CMS NCDs/LCDs, specialty society guidelines, peer-reviewed literature, and proprietary medical policies.