Clinical Pharmacist, Coverage Determination (Hybrid/Remote)

VIVA HEALTH; Alabama; Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Health coverage

401(k) plan

Paid time off

Holidays & floating day

Tuition assistance

Flexible spending accounts

Community service time off

Life insurance

Wellness program

Training & development

Employee assistance program

Job summary

VIVA HEALTH in Alabama is seeking a Clinical Pharmacist, Coverage Determination, to lead clinical pharmacy decisions within the health plan. The role serves as a clinical reviewer for Commercial employer groups and Medicare Part D determinations, ensuring alignment with policy and CMS requirements.

The position requires Alabama pharmacist licensure (PharmD) or active RPh license, strong IT skills including Microsoft Office, and excellent written and oral communication.

Qualifications

• Registered Pharmacist (Rph) or Doctor of Pharmacy (PharmD) and Alabama license.
• Proficient computer skills including Microsoft Office.
• Excellent oral and written communication skills.

Responsibilities

• Perform Coverage Determination reviews for Medicare and Commercial lines.
• Research individual cases and render decisions with Pharmacy department leaders or Medical Director input.
• Assist in maintaining criteria for 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.
• Ensure processes are carried out in accordance with CMS and other regulatory requirements.

Skills

Oral and written communication

Education

Pharmacist (PharmD) or Alabama-licensed pharmacist

Tools

Microsoft Office

Job description

VIVA HEALTH in Alabama is seeking a Clinical Pharmacist, Coverage Determination, to lead clinical pharmacy decisions within the health plan. The role serves as a clinical reviewer for Commercial employer groups and Medicare Part D determinations, ensuring alignment with policy and CMS requirements.

The position requires Alabama pharmacist licensure (PharmD) or active RPh license, strong IT skills including Microsoft Office, and excellent written and oral communication.