Clinical Pharmacist: Coverage Determination Leader

Viva-Health; Birmingham (AL); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Comprehensive Health Coverage

401(k) Savings Plan with company match

Paid Time Off

9 Holidays + Floating Holiday

Tuition Assistance

Flexible Spending Accounts

Life Insurance and Disability Coverage

Employee Wellness Program

Training and Development Programs

Job summary

Viva Health, based in Birmingham, AL, seeks a Clinical Pharmacist for Coverage Determination to provide leadership on clinical pharmacy decisions and programs. You will serve as a clinical reviewer for Medicare Part D and Commercial lines, guiding determinations and ensuring alignment with CMS policies.

Join Viva Health, a Premier health plan with strong ties to UAB Health System, offering comprehensive benefits, PTO, tuition assistance, retirement plans, and development programs while

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.

Responsibilities

• Lead Coverage Determination reviews for Medicare and Commercial lines per applicable policies and regulations.
• 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 developing and maintaining coverage determination decision trees.
• Ensure processes are carried out in accordance with CMS and other regulatory requirements.

Skills

Communication skills

Microsoft Office

Oral and written communication

Clinical pharmacy knowledge

Job description

Viva Health, based in Birmingham, AL, seeks a Clinical Pharmacist for Coverage Determination to provide leadership on clinical pharmacy decisions and programs. You will serve as a clinical reviewer for Medicare Part D and Commercial lines, guiding determinations and ensuring alignment with CMS policies.

Join Viva Health, a Premier health plan with strong ties to UAB Health System, offering comprehensive benefits, PTO, tuition assistance, retirement plans, and development programs while