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Job Description
- Req#: CLINI002594
- 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
- Ability to prioritize effectively and collaborate with all levels of associates
- Ability to interpret regulatory technical guidance and apply it to daily work
- 3 years’ experience in Medicare Advantage Coverage Determinations, health plan, or pharmacy benefits management and/or a managed care pharmacy residency
- Experience in the RX Claims system
- Knowledge of Medicare Parts C & D Enrollee Grievances, Organization/Coverage Determinations and Appeals Guidance
- Knowledge of health plan pharmacy benefit administration processes
VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is seeking a Clinical Pharmacist to join our team in Birmingham, AL!
The Clinical Pharmacist will provide leadership at the health plan in regard to clinical pharmacy decisions and programs. This individual will serve as the primary clinical reviewer for the Plan’s Medicare Part D Coverage Determinations and provide periodic assistance with the commercial business Coverage Determinations. This position will monitor prescription drug utilization, coverage policies and costs to identify and address issues related to quality and cost-effectiveness. This role will assist in supporting Pharmacy Department efforts towards attainment of a minimum 4 Star CMS Medicare Advantage Plan Star Rating.
VIVA HEALTH is the first and only Alabama-based plan to be named an overall 5-out-of-5 Star Medicare Advantage Plan. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. We also offer a great benefits package, including tuition reimbursement for employees and dependents, 401(k), paid parental leave, and paid day for community service, just to name a few! Come join our team!
REQUIRED:
PREFERRED:
Click Here to learn more about how VIVA HEALTH is building a culture where diverse voices, backgrounds, and perspectives are welcomed and celebrated!
About the company
Viva Medicare offers a variety of affordable Medicare Advantage plans to Alabamians who are eligible for Medicare benefits. By focusing on local customer service, competitive benefits and cost savings, as well as an extensive network of doctors and hos...
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