Clinical Pharmacist, Quality Improvement

Job Description

Job Description

Clinical Pharmacist, Quality Improvement

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular work onsite at the VIVA HEALTH corporate office and some work-from-home opportunities.

The Clinical Pharmacist, Quality Improvement (QI) will work directly with department leadership to participate on a team of health care professionals that conduct outreach and intervention with members to improve the members health care quality with focus on appropriate prescribing and medication adherence. This pharmacist will be responsible for addressing quality gaps identified in the STARS quality bonus measures and other quality measures.

This individual may also assist with Coverage Determinations and provide leadership at the health plan in regard to clinical pharmacy decisions and programs. This role may serve as a clinical reviewer for the Plan’s Commercial (employer groups) and Medicare Part D Coverage Determinations. This position may travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured in accordance with Company policy.

Why VIVA HEALTH?

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

See more about the benefits of working at Viva Health -

Key Responsibilities

• Perform outreach directly to members and through VIVA HEALTH team members in other departments including Provider Engagement, Care Management, and Member Services to develop trusting, professional, caring relationships with members.
• Work with the care team to identify and address barriers to Part D medication adherence and other negative quality indicators such as high-risk medications, opioid overutilization, and polypharmacy as appropriate.
• Assessments may be conducted in person in the member’s home or alternate setting via video conferencing or by telephone.
• Document all interactions with members, family members, caregivers, and health care professionals. Track outcomes and provide feedback to Pharmacy department management.
• Collaborate with the member’s PCP, specialists, and other treating providers to close quality gaps in prescribing and medication adherence. Actively participate in evidence-based medication management quality initiatives.
• May 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.
• May assist in maintaining criteria for pharmacy related coverage determinations, exception requests, complaints, and appeals, ensuring that criteria and decisions are properly communicated and applied.

REQUIRED:

• Registered Pharmacist (Rph) or Doctor of Pharmacy (PharmD)
• 2 years’ depending on certification or a completed Pharmacy Residency
• Licensed Pharmacist in good standing with the State of Alabama
• Valid driver's license in good standing
• May require significant face-to-face member contact, with duties regularly performed away from the principal place of business
• Willing to submit to vaccine testing and screening
• Ability to work flexible hours
• Excellent computer skills including Microsoft suite of products
• Comfortable working in patient’s homes
• Strong verbal communication skills
• Strong assessment skills

PREFERRED:

• Experience in a long-term care or inpatient hospital or comparable setting or ambulatory care setting
• Geriatric certification, BCPS certification and/or MTM certification
• Additional Languages (Spanish)