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Job description
Clinical Pharmacist, Coverage Determination
The Coverage Determination Pharmacist will provide leadership at the health plan regarding clinical pharmacy decisions and programs. This position will serve as a clinical reviewer for the Plan's Commercial (employer groups) and Medicare Part D Coverage Determinations.
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
Tuition Assistance
Flexible Spending Accounts
Healthcare Reimbursement Account
Paid Parental Leave
Community Service Time Off
Life Insurance and Disability Coverage
Employee Wellness Program
Training and Development Programs to develop new skills and reach career goals
Employee Assistance Program
Key Responsibilities
Perform Coverage Determination reviews (prior authorizations, formulary exceptions, etc.) for both Medicare and Commercial lines of business. Reviews will be completed in accordance with applicable policies and procedures, regulations, and guidelines.
Research individual cases and render decisions with Pharmacy department leaders or Medical Director input as needed.
Assist in maintaining criteria for pharmacy related coverage determinations, exception requests, complaints, and appeals, and ensure criteria and decisions are properly communicated and applied.
Assist department management in the development and maintenance of coverage determination decision trees.
Assist in ensuring processes are carried out in accordance with Centers for Medicare & Medicaid Services (CMS) and other regulatory requirements.
Required Qualifications
Registered Pharmacist (Rph) or Doctor of Pharmacy (PharmD)
Licensed Pharmacist in good standing with the State of Alabama
Excellent oral and written communication skills
Good computer skills including Microsoft suite of products
Preferred Qualifications:
5 years' experience in Medicare Advantage Coverage Determinations, health plan, or pharmacy benefits management
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Worksite address
birmingham, AL, 35275, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.