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San Diego, California, United States
Onsite
Not Available
“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”
This position is not eligible for Sponsorship.
MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!
Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.
At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!
Summary
The Rebate Clinical Program Manager (CPM) optimizes the clinical quality and cost-effectiveness of drug rebate. Focuses on operational management of medical drug utilization by employing analytical tools. Works within an account team structure to achieve overall account and company financial goals. Relies on data and performance indicators, as well as experience and judgment, to identify and promote performance improvement opportunities which attain the aligned goals of Medlmpact and assigned clients.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
· Provides recommendations to assigned clients that align with both the clients' and Medlmpact's mutual goals. The strategic recommendations include: HCPCS/NDC analysis and suggestions, on-line rebate system edits and restrictions, and recommendations for accurate medical billing.
· Provides clinical consultative services in accordance with CMS dispute resolution processes. The CM's focus will be centered on using a variety of analytical tools and clinical resources to identify opportunities which simultaneously improve the data integrity of the rebate program.
· Performs provider audits and provider education for medical claim billing in regards to rebate processing.
· Conducts claims analysis for incorrect, aberrant quantities billed for rebate invoicing.
· Develops, maintains and recommends clinically appropriate unit of measure conversion for all NDC billing to CMS rebate units.
· Other activities are centered on client specific requests and involve production of reports and providing financial and drug utilization data that assist the state(s) in determining their financial solvency, drug purchasing policies and allocation of received rebate monies.
· Ensures timely and accurate review of claim data, according to policy, with appropriate intervention recommendations.
· Supports 340B strategic initiatives.
Supervisory Responsibilities
No supervisory responsibilities
Education and/or Experience
PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas.
Computer Skills
To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases.
Certificates, Licenses, Registrations
Registered Pharmacist
Other Skills and Abilities
Reasoning Ability
Mathematical Skills
Language Skills
Competencies To perform the job successfully, an individual should demonstrate the following competencies:
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes, or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).
Work Location
This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.
Working Hours
This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.
Travel
This position requires domestic travel of up to 10% of the time.
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
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