Exemption Status:

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 Description

Summary

Participates in the execution of an effective quality assurance program to ensure that the operational component of MedImpacts PBM programs and services meet client requirements and government regulations. Works under general supervision with a limited degree of independence.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Develop and execute departments quality assurance procedures and participate in quality improvement initiatives. Ensure that deliverables are on time and meet the quality levels expected by Medlmpacts internal and external customers and the Centers for Medicare and Medicaid Services (CMS).
• Understanding of PBM regulations and related CMS guidance. Responsible for proactive review of all CMS regulation and guidance. Provides assessment of requirements when CMS revises guidelines and implements quality and compliance monitoring changes to ensure compliance to new guidelines.
• Understanding of quality methodologies practices and techniques.
• Execute and track quality and compliance review projects. Develop quality review procedures perform tests and document test results. Participate in evaluations and audits of PBM services provided by Medlmpact. Implement corrective action plans in response to negative findings
• Test multiple files with high volumes of data
• Interface with internal operational areas and with external customers to improve the quality of customers implementation of the PBM program. Areas include Part D Benefit Setup Part D Pharmacy Network Setup CMS Plan Finder Submissions Member Part D Explanation of Benefit Statements CMS Reporting Prescription Drug Event Reporting Part D Policy and Procedures and other PBM services provided by Medlmpact
• Respond to inquiries from internal and external customers regarding quality review and compliance policy and procedures. Implement corrective action plans in response to negative findings.
• Keep management team updated on significant issues or developments identified during quality control activities and actions being taken to improve the situation.

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 Experience

BS/BA and 3 years experience or equivalent combination of education and experience

Computer Skills

Previous experience writing SQL queries Automation Testing File Transfer Protocol and UNIX is highly desirable.

Intermediate to advanced skills in Microsoft Office with an emphasis on Word Excel MS Access and Project. Intermediate to advanced skills in SQL queries.

Certificates Licenses Registrations

None required

Other Skills and Abilities

• Knowledge of Quality Assurance methodologies and practical application. Ability to research assess audit and apply information to practices and standards. Strong analytical and problem solving ability and in-depth understanding of PBM regulations and related CMS guidance
• Demonstrated ability to work in a fast paced environment learn quickly appear for work on time follow directions from a supervisor interact well with co-workers understand and follow work rules and procedures comply with corporate policies goals and objectives accept constructive criticism establish goals and objectives and exhibit initiative and commitment. Demonstrate ability to meet or exceed the competencies as listed.
• Healthcare Managed Care Government Programs or PBM Quality experience is preferred

Reasoning Ability

• 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.

• Ability to interpret a variety of instructions furnished in written oral diagram or schedule form.

Mathematical Skills

• Ability to add subtract multiply and divide in all units of measure using whole numbers common fractions and decimals. Ability to compute rate ratio and percent and to draw and interpret bar graphs.

• Ability to apply concepts such as fractions percentages ratios and proportions to practical situations.

Language Skills

• Ability to write reports business correspondence and procedure manuals.

• Ability to read analyze and interpret general business periodicals professional journals technical procedures or governmental regulations.

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).

Work Location

This position must work on-site at the San Diego Headquarters for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees colleagues clients or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders. Remote work is not an option for these purposes.

Working Hours

This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore one must have the ability to work nights weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires no travel however attendance maybe required at various local conferences and meetings.

The Perks:

• 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 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.

Equal Opportunity Employer Male/Female/Disabilities/Veterans

OSHA/ADA:

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.

Disclaimer:

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.