What are the responsibilities and job description for the Clinical Pharmacist, Quality Improvement position at Triton Health Systems?

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.

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, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve 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 - https : / / www.vivahealth.com / careers / benefits

Job Description

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.

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.

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)

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Clinical Pharmacist, Quality Improvement

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