“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!
Job Summary
Manages the Fraud, Waste & Abuse (FWA) products, pharmacy audits, and services to ensure the delivery of effective services.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
· Identifies and assesses Fraud, Waste & Abuse product and service opportunities internally to
verify the Company is in line with the external marketplace. Evaluates and enhances FWA
product and services for current and potential clients.
· Oversees and defines FWA product strategy and roadmap working with the Enterprise Product
Development team to ensure Medlmpact's competitiveness with other PBMs.
· Develops and implements strategy and services to meet organizational, client audits and the
department's needs. Communicate strategy to internal stakeholders.
· Supports the audit team in the initiation of new products and to operationalize those products.
· Responsible for product and business development of FWA Services. Supports the
development of MIDAS, Medlmpact's internally created software for market research, launch,
sales, and business opportunities. Supports future enhancements and upgrades of MIDAS.
· Provides management with reports and analysis of information by preparing short-term and
long term product sales forecasts and special reports and analyses, answering questions and
requests
· Delivers the department's operating plan which includes achievement of growth objectives,
market share, revenue, profit and return on investment for all the channels/categories of
business and/or key customers
· Partners with the Marketing department to manage and implement marketing activities related
to Fraud, Waste & Abuse such as the Annual Client Conference, client requests, products and
services through research, strategic planning, and implementation.
· Presents to current potential domestic and international clients to generate sales leads as well
as provide client support. Develop relationships within the industry, attends conferences;
pitches Medlmpact products. Acts as a liaison for enhanced FWA programs.
· Designs audit, FWA programs to reduce unnecessary drug costs, recoup monies and provide
cost savings for Medlmpact clients.
· Oversees and manages analytics in Pharmacy Compliance, FWA including ProfiULoss reporting,
predictive modeling, and ad-hoc clients reports
· Ensures all audit contractual obligations are completed in a timely manner within MedImpact's
level of expectation.
· Develop and track internal KPI metrics and manage client ROI performance.
· Intervenes and resolves issues, problems, and/or concerns from clients; informs senior
management regarding client issues that potentially could have any adverse impacts.
· Work with Data Scientist to develop and maintain supervised machine learning models and
support automation of machine learning models.
· Other duties as assigned.
Supervisory Responsibilities
No supervisory responsibilities
Client Responsibilities
This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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.
Education and/or Experienc
BS/BA and 7+ years’ experience or equivalent combination of education and experience, and 4 years' of SME in respective areas
Computer Skills
Strong proficiency with personal computers and MS Office products to include a good working knowledge of MS Word, Excel, Access and Outlook. Familiarity with relational database systems. Knowledge of SQL software front end such as Med Optimize highly desirable.
Certificates, Licenses, Registrations
None required.
Other Skills and Abilities
· Prior pharmacy benefit management experience preferred.
· Ability to read and interpret prescriptions.
· Knowledge of medications and usual dosages.
· Excellent knowledge of the practice of pharmacy, including statutory laws, regulations, and
methods of filling and filing prescriptions.
· Ability to prioritize tasks and initiatives across multiple business areas.
Reasoning Ability
· Ability to define problems, collect data, establish facts, and draw valid conclusions.
· Ability to apply common sense understanding to carry out instructions furnished in written, oral,
or diagram form. Ability to deal with problems involving several concrete variables in
standardized situations.
Mathematical Skills
· Ability to calculate figures and amounts such as discounts, interest, commissions, proportions,
percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and
geometry.
Language Skills
· Ability to effectively present information and respond to questions from groups of managers,
clients, customers, and the general public.
· Ability to write reports, business correspondence, and procedure manuals.
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 accommodations 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.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations 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).
Working Hours
This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable 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.
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.