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Magellan Health jobs in San Diego, CA

- 66 jobs
  • Personal Financial Counselor- ARNG San Diego CA

    Magellan Health 4.8company rating

    Magellan Health job in San Diego, CA

    This position will provide personal financial services at assigned military installations. Primary responsibilities include the full breadth of personal financial counseling services to military service members and their families at military installations. Services include education and counseling addressing financial services that may include, but are not limited to, one-on-one counseling, consultation with a commander or with another provider or staff, conducting briefings and presentations, or providing referral resources to a participant outside the context of a counseling session. Works closely with the installation and military branch Points of Contact (POC) to assure that the program is providing within scope and meets the needs of the installation. Provides personal financial counseling and management services directly to service members and their families. Assists service members in establishing a spending plan for extended absences. Develops and makes available informational financial materials to service members and families. Coordinates, publicizes and provides a wide variety of Personal Financial Management classes/workshops, e.g., topics across the military lifecycle, including, but not limited to, arrival at first duty station, pre- and post-deployment, and personal and career events outlined in DoDI 1322.34. Responds to requests for age-appropriate classes or seminars. Possess the skills to effectively utilize virtual counseling or other electronic modes of communication, such as web based, secure online chat, or video-based communications and secure video teleconference sponsored by the customer. Virtual PFC support may only be authorized by OSD FINRED Program office. Manages duty to warn situations according to Department of Defense (DoD) protocol. Communicates with leadership and participates in regular individual and group supervision, sharing information regarding trends and issues on the installations to which the counselor is assigned. Participates in regular in-services/training, quality improvement committees or other contract activities as assigned/appropriate. All other duties as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Bachelor's degree required. May consider applicants with an associate degree plus 4 years' experience in lieu of bachelor's degree. May consider applicants with a high school diploma plus 6 years' experience in lieu of a bachelor's degree. 3+ years of financial counseling experience. Must be a U.S. citizen and speak fluent English. If required by the contract, must be bilingual in English and Spanish. Be able to obtain a favorably adjudicated Tier 2 investigation. Must be able to pass the Congressionally Mandated Disclosures for Organizational Conflicts of Interest (OCI) process. Must have one of the following certifications: Accredited Financial Counselor (AFC), Certified Financial Planner (CFP), or Chartered Financial Consultant (ChFC). General Job Information Title Personal Financial Counselor- ARNG San Diego CA Grade 23 Work Experience - Required Financial Counseling Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's Education - Preferred License and Certifications - Required AFC - Accredited Financial Counselor - EnterpriseEnterprise, CFP - Certified Financial Planner - EnterpriseEnterprise, ChFC - Chartered Financial Consultant - EnterpriseEnterprise, DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred Salary Range Salary Minimum: $53,125 Salary Maximum: $84,995 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
    $53.1k-85k yearly Auto-Apply 16d ago
  • Government Programs and Services (GPS) Specialist I

    Medimpact 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$52,693 - $69,160 - $85,626 “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 Essential Duties and Responsibilities include the following. Other duties may be assigned. This position supports MedAccess adjudication processes. Communicates CMS guidance changes and updates to the clients. Keeps up-to-date with CMS guidance changes and how MedImpact implements changes in-line with state and federal guidelines. Provides internal and external support to ensure MedImpact and its clients adhere to processes and to ensure compliance with related regulations. Works across the organization to expeditiously resolve issues, escalate service recovery efforts and provide timely feedback. Ensures client comprehension of MedImpact's processes and CMS guidance. Explains new programs and enhancements to existing programs to clients. Communicates major file and report changes to clients by having a detailed understanding of any changes. Adheres to strict procedural and quality CMS standards and corporate guidelines; aids in the creation of documentation; analyzes claims while applying a thorough understanding of assigned clients' technical and service requirements. Works with internal departments (Information Technology, Operations Client Business Analyst and others) to resolve client specific claims issues. Maintains familiarity with the various plan designs, benefit setups, pharmacy networks, claims adjudication and formulary for assigned clients. Keeps the “Client Profile” updated with requisite information. Provides client-facing support for project Implementation and/or internal implementation support including Sales/Account Management support for Business Development. Provides team representation and management of client interfaces regarding specific program aspects. Completes project activities within the prescribed time frame to ensure timely and accurate delivery of services. Manages client expectations on issue resolution and provides customer support to address any action items/issues or problems by working proactively under strict deadlines. Supervisory Responsibilities This job has 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; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients; Manage difficult or emotional client situations. 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 Bachelor's degree (or equivalent combination of education and experience) along with 2+ years' experience in a related industry. Good familiarity with regulatory agencies and CMS guidance a plus. Experience in PBM, pharmaceutical, or managed healthcare industry a plus. Computer Skills To perform this job successfully, an individual should have knowledge intermediate knowledge of MS Office Suite (Word, Excel, PowerPoint), Outlook or other email system and databases. Certificates, Licenses, Registrations Pharmacy Technician, not required, but preferred Other Skills and Abilities Good understanding of Center for Medicare and Medicaid Services (CMS), State and Federal regulations and guidance with the ability to assimilate and keep up to date with changes. Possesses a cross-functional understanding of GPS processes within different departments preferred. Intermediate to advanced understanding of claim processing concepts. Strong Interpersonal skills with the ability to work effectively with differing personalities and levels of employees. Well defined decision-making skills, including proven problem analysis and discerning communications under pressure. Demonstrated business acumen combined with a strong understanding of the business processes associated with PBM service delivery. Able to work under tight deadlines in a results-driven department. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Mathematical Skills Ability to calculate figures and amounts such as discounts, proportions, percentages. Ability to apply concepts of basic algebra. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. tools (including Excel, Word and Outlook). Competencies To perform the job successfully, an individual should demonstrate the following competencies: Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to teamwork, resolving conflicts effectively and with respect for others' viewpoints, respecting differences and building strong relationships and networks. Job-specific Expertise - Demonstrates solid command of relevant knowledge, skills, techniques and technologies, keeps current with recent developments and best practices in the field, and establishes self as the go-to person for up-to-date knowledge in his or her area. Problem Solving - Analyzes problems logically to identify root causes, seeks input from a wide range of sources, asks insightful questions and formulates effective solutions. Responsiveness - Responds promptly, appropriately and effectively to requests, feedback and new developments, making sure that all relevant concerns and requirements are understood and addressed. 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; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 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. The noise level in the work environment is usually moderate. Work Location This position works on-site at the San Diego Headquarters (or other company location) 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. Periodic scheduled remote work may be permitted as allowed under the department's policy and with management approval. 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. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $52.7k-69.2k yearly Auto-Apply 57d ago
  • Clinical Account Executive

    Medimpact 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$108,515 - $152,464 - $196,412 “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 The Clinical Account Executive I is responsible for the strategic management of client relationships, focusing on implementing, overseeing, and optimizing clinical programs and services that are part of the PBM offerings. This role supports the client's clinical strategy and ensures alignment with company goals. Essential Duties and Responsibilities include the following. Other duties may be assigned. Client Relationship Management: Build and nurture strong, long-term relationships with healthcare clients to ensure satisfaction and retention Serve as the primary clinical point of contact for assigned accounts Conduct regular client meetings to review clinical program performance and outcomes Clinical Program Implementation/Support: Provide expert clinical guidance and support to clients Lead the implementation of clinical programs and initiatives tailored to client needs Ensure seamless integration of clinical services with client operations Monitor and report on the effectiveness of clinical interventions Consultation and Strategy Development: Collaborate with clients to develop and implement clinical strategies and programs Provide expert advice on clinical trends, formulary management, and drug utilization Work with internal stakeholders to customize solutions for clients Keep clients informed about industry trends and innovations Data Analysis and Reporting: Analyze clinical data to identify trends, opportunities, and areas for improvement Prepare and present detailed reports on clinical performance and cost savings Utilize data to help clients achieve their healthcare objectives and financial targets Compliance and Risk Management: Ensure compliance with relevant regulatory requirements and company policies Cross-functional Collaboration: Work closely with internal teams, including operational, sales, and account management, to ensure cohesive service delivery Support the development of marketing materials and proposals for new client opportunities Facilitate communication and collaboration between clinical and non-clinical teams 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 Experience CL11 - 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 Excel and relational databases. Individual should also be familiar with SalesForce. Certificates, Licenses, Registrations Current, active, and valid registered Pharmacist License, without restrictions, in any state. May require licensure in a specific state, as required. Other Skills and Abilities Strong analytical and problem-solving capabilities Excellent communication and presentation skills Ability to work independently and as part of a team Knowledge of PBM operations, drug formulary systems, and healthcare regulations Reasoning Ability Ability to deal with nonverbal symbolism (formulas, scientific equations, graphs, musical notes, etc.,) in its most difficult phases. Ability to deal with a variety of abstract and concrete variables. Ability to define problems, collect data, establish facts, and draw valid conclusions. Mathematical Skills - Choose up to 1 from each drop-down list. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Language Skills - Choose up to 1 from each drop-down list. Ability to effectively present information to top management, public groups, and/or boards of directors. 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). 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 25% of the time. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $108.5k-152.5k yearly Auto-Apply 60d+ ago
  • Technical Project Manager III, Medicaid, Fee-for-Service

    Medimpact 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$110,982 - $155,376 - $199,769 “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 Using the industry's best practices for project management along with a solid working knowledge of the system development life cycle and IT Infrastructure deployment, the GPS Technical Project Manager III plans, directs, and coordinates Information Technology projects and programs related to Government Programs products and services to ensure that project goals are accomplished within prescribed time frames. The position is responsible for ensuring project goals and requirements are met on schedule, within budget and are successfully completed The Technical Project Manager III adheres and adapts to current processes. Identifies and recommends improvements to current practices. Manages escalated issues and demonstrates appropriate escalation of issues as needed. Leads the efforts of a multi-disciplinary project team through various stages of the project lifecycle, including vision and scope, requirements analysis, solution, design, development, and implementation. Requires close partnership with internal/external client counterparts, Information Technology (IT), Government Programs and Services, the Enterprise and GPS Project Management Offices, Operations, Health Services, and other departments as needed throughout the duration of the project. The position works in partnership with the centralized GPS Department as well as with enterprise-wide functional leaders, stakeholders and project team members to manage complex Information Technology projects across multiple programs, including Medicaid programs (State FFS program, Medicare/Medicaid Program (MMP), Medicaid Managed Care (MMCO), Children's Health Insurance Plan (CHIP) as well as other public federally-facilitated or state-based programs. Essential Duties and Responsibilities include the following. Other duties may be assigned. Initiation Defines project objectives/goals; determines the scope of each project as well as the project charter. Coordinates with key project personnel for requirements, technical analysis, design, and documentation of solutions to meet business requirements and drive technical problem resolution. Facilitates and manages vendor selection process and vendor onboarding process. Planning/Development Develops and coordinates the project plan by identifying project deliverables, milestones, scheduling, and required tasks. Uses planning and analytical skills in support of requirements gathering, writing functional specifications, SQL queries and test plan development activities. Helps ensure solution design meets standard architecture considerations and approval to include Standard database structures, (2) Code standards (3) Common components and reusable programs, (4) Security and Performance levels, (5) System interfaces and dependencies. Helps ensure that infrastructure design meets standard architecture considerations for high availability, redundancy, and disaster recovery. Working with stakeholders and Resource Management, determines staffing requirements and allotment of available resources to each project phase. Works with assigned project staff and/or clients to gather and document project requirements. Communicates with project team to outline work plan, assign duties, responsibilities, and scope of authority. Ensures that all responsibilities are clearly communicated, from requirements gathering to working with QA department to ensure solid quality assurance plan. Production/Execution Facilitates regular project status meetings to assess progress versus milestones and identify areas of potential concern in adequate time in order to mitigate risk. Tracks projects and issues closely, fosters collaboration from both the business and technology groups and leads issue resolution meetings during projects. Manages risks throughout the project by identifying, communicating, tracking, and mitigating. Meets with project personnel to provide technical advice and to resolve problems. Ensures all follow-up action items are owned and closed out by the relevant owners Monitors/Controls Manages and monitors project status by establishing a regular meeting schedule with project teams. Directs and coordinates activities of project personnel to ensure project progress is on schedule and outstanding items or issues are successfully resolved. Creates and communicates regular status reports for management, clients, and the project team. Provides formal and ad-hoc updates to management as required. Prepares project status reports and keeps clients and others informed of project status and related issues. Ensures completeness of all project documentation throughout the project lifecycle and for obtaining appropriate approvals at each phase of the project. Participates in reviewing, monitoring, and gaining appropriate approvals for project documentation throughout the project lifecycle including Vision and Scope, Technical Specifications, Architecture Specifications and Objectives of the Project. Ensures completeness of all project documentation throughout the project lifecycle and for obtaining appropriate approvals at each phase of the project. Monitors and manages project constraints including scopes, cost, timeline, resources, and risks. Closing Assumes responsibility for delivery by ensuring all components of the project are successfully completed (including lessons learned documentation. Coordinates and interfaces with other departments for project transition. Other Mentor less experienced project managers. Strong emphasis on strategic thinking as it relates to the management of assigned projects and on-going use of the solution. Communicates well with technical and business stakeholders. Builds and maintains good working relationships with team members, vendors and other departments involved in projects. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BS/BA and 8+ years' experience or equivalent combination of education and experience, and 4 years of SME in respective areas This position requires experience with Medicaid or Government health, with a strong preference for Medicaid Fee-For-Service experience. Computer Skills Proficient with Microsoft Office (Word/Excel/PowerPoint), MS Outlook and MS Project. Must be proficient with Project Scheduling Software. Familiarity with MedImpact developed applications helpful (MedAccess, MedResponse, etc.) Certificates, Licenses, Registrations None required; PMP certification is highly desired Other Skills and Abilities Experience in all phases of software development lifecycle and IT infrastructure deployments preferred Prior experience in PBM, pharmaceutical, or managed healthcare industry is a plus Must have good negotiation skills, well-developed facilitation and collaboration skills Proven leader and team player Strong client management skills Ability to work in a matrix management organization Driven and committed to overcome obstacles and deliver the project on time Delivery-focused, yet flexible and creative when called upon Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to define problems, collect data, establish facts, and draw valid conclusions. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. 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 read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints. 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 10 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. 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 reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $111k-155.4k yearly Auto-Apply 23d ago
  • Appeals & Grievances Coordinator I

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Non-Exempt)$17.92 - $22.85 - $27.78 “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 The Appeals and Grievances (A&G) team is responsible for managing all aspects of the appeals and grievances process, including-but not limited to-intake, processing, notification, and compliance. The Appeals and Grievances Coordinator I serves as a key member of the A&G team, processing appeal and grievance requests in accordance with established standards for accuracy, timeliness, productivity, client performance commitments, and regulatory requirements (e.g., state and federal regulations, professional accreditations). This position reports directly to the Supervisor of Appeals and Grievances Operations and is led by the Lead Coordinator (Coordinator III). The Coordinator I utilizes various business applications-such as MedAccess, MedResponse , FileNet and RightFax - to perform analysis, retrieve information, and enter data as needed to complete assigned tasks. Strong reasoning skills are essential for evaluating appeal and grievance requests for appropriateness and ensuring adherence to required processes. The ability to multitask and cross-train in both appeals and grievances processing is essential to support the weekend rotation schedule. Interact with internal and external customers as required. Work under general supervision, relying on work instructions, policies & procedures, and available company resources to perform the functions of the position efficiently and effectively. Essential Duties and Responsibilities include the following. Other duties may be assigned. Evaluate and process Appeals and Grievances per establish work instructions and approved departmental documents. Perform and document outreach activities (including outbound calls and faxes) to obtain information necessary for processing Appeals and Grievances or to communicate the results of Appeal and Grievance reviews. Ensure Appeals and Grievances are finalized within the required turnaround time (TAT) in accordance with applicable laws and company policies. Must be able to cross-train across the appeal and grievance task divisions. Participating in the rotating weekend on-call schedule as needed. Protect and maintain confidentiality and privacy of all members' personal and health information in accordance with federal requirements and company policies. Must comply with company and department policies, procedures, rules and regulations. Must possess the ability to adapt to departmental changes as required for the needs of the business. Must be flexible with shift changes. 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 GED/HS Diploma and 1+ year experience or equivalent combination of education and experience Computer Skills To perform this job successfully, an individual should have knowledge of MS Office Suite. Proficiency of knowledge of Microsoft Word and Microsoft Excel. Certificates, Licenses, Registrations Certified Pharmacy Technician and/or state licensure as a Pharmacy Technician required. Certified Pharmacy Technician Certification preferred. Other Skills and Abilities Oral Communication: Speak clearly and persuasively in positive or negative situations. Listen and obtain clarification when needed. Responds well to questions. Written Communication: Write clearly and informatively. Edit work for spelling and grammar. Teamwork: Balance team and individual responsibilities. Exhibit objectivity and openness to others' views. Give and welcome feedback. Contribute to building a positive team spirit. Put the success of the team above own interests. Support everyone's efforts to succeed. Organizational Support: Follow policies and procedures. Complete required tasks correctly and on time. Support organization's goals and values. Benefit organization through outside activities. Support affirmative action and respect diversity. Reasoning Ability Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. Ability to define problems, collect data, establish facts, and draw valid conclusions. 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 read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. 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 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 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 may be 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $27.8 hourly Auto-Apply 43d ago
  • Pharmacy Resident - Managed Care

    Medimpact 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Non-Exempt)$19.11 - $24.65 - $30.19 “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 DescriptionMedImpact's Managed Care Pharmacy Residency Program is a one-year program that develops future managed care leaders by building a strong foundation of knowledge in both clinical and managed care principles. By working across multiple teams serving all lines of business, the diverse experience gained will amply prepare the resident for a career in managed care pharmacy.The Managed Care Pharmacy Resident provides support to the Government Programs and Services (GPS) team and other departments through managed care learning experiences (rotations) and longitudinal projects. The rotations/projects will include a breadth of disciplines including clinical operations, utilization and formulary management, clinical account services, quality assurance and improvement, government program management, analytics and research.Essential Duties and Responsibilities include the following. Other duties may be assigned. Perform cost savings and member impact analyses after learning benefit design and utilization management strategies. Contribute to clinical quality programs, such as Drug Utilization Review (DUR), Transitions of Care and other initiatives to improve HEDIS and CMS Star Ratings. Support clients by developing and implementing quality and cost savings initiatives and managing custom formularies across all lines of business. Participate in the management of government programs to evaluate and facilitate regulatory programs. Perform quality program oversight and develop quality improvement initiatives while supporting oversight audits. Evaluate prior authorization requests and understand the regulatory requirements governing prior authorization reviews, which includes four hours of weekly staffing. Assist in P&T material preparation and weekly drug updates. Present at MedImpact P&T Committee meetings. Develop presentation skills to lead meetings while learning to manage projects and navigate corporate complexities. Conduct a longitudinal research project designed for presentation at AMCP Annual Meeting. Education and/or Experience PharmD from an ACPE-accredited school of pharmacy Minimum GPA of 3.0 Managed Care experience preferred Certificates, Licenses, Registrations Must obtain Registered Pharmacist license in state of residence and Kentucky by October 1st of the program year. Other Skills and Abilities Strong analytical and problem-solving capabilities Excellent communication and presentation skills Ability to work independently and as part of a team Knowledge of PBM operations, drug formulary systems, and healthcare regulations Reasoning Ability Ability to deal with nonverbal symbolism (formulas, scientific equations, graphs, musical notes, etc.,) in its most difficult phases. Ability to deal with a variety of abstract and concrete variables. Ability to define problems, collect data, establish facts, and draw valid conclusions. Language Skills - Choose up to 1 from each drop-down list. Ability to effectively present information to top management, public groups, and/or boards of directors. 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). 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 25% of the time. Please include Letter of Intent AND Curriculum Vitae (CV) in Workday along with submission of application. Official transcript must be emailed directly from pharmacy school to ******************************. Three letters of recommendation must be emailed directly from letter writers to ******************************. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $30.2 hourly Auto-Apply 8d ago
  • Clinical Specialist

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Non-Exempt)$52.17 - $73.30 - $94.43 “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 The Clinical Specialist manages accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This position focuses on initiating, supporting, and continuing cost-effective, rational drug, and disease therapy, utilizing distinct but inter-related management and cross-departmental functions. Essential Duties and Responsibilities include the following. Other duties may be assigned. Responsible for providing clinical review support services to client plan(s) contracting for clinical services. This includes reviewing prior authorization requests and either deciding to approve or deny the request. Support services also include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and requests as required by client contracts and Utilization Management delegation agreements. Review medication request guidelines for clinical appropriateness and operational efficiency. Assist in the revision and creation of new or existing medication request guidelines as indicated. May consult regarding a PA request directly with a client representative or an internal Subject Matter Expert or contact a dispensing pharmacist, prescriber or prescriber representative to obtain additional information. Provide drug information support. The position may also need to follow general guidance from the client on the handling of specific request types (non-formulary, quantity exceptions, etc.) Research and provide clinical literature documentation to support prior authorization decisions as indicated. Coordinate and assist with projects associated with prior authorization program development, implementation and internal and external communications. Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review. This includes PAs that do not follow proper protocol of initial reviews before sending to the Clinical Specialists. Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process. Handling Provider, Pharmacy and member calls to complete prior authorization and Peer to Peer requests based on client specific requirements Assist with training to support growth of the Prior Authorization Department. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. 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 Word Processing software. Certificates, Licenses, Registrations Current, unrestricted Registered Pharmacist license in any state of the United States. Other Skills and Abilities Excellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment. Expertise in clinical application of pharmacy practice. Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Language Skills Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. 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 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. 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 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 may be 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $94.4 hourly Auto-Apply 44d ago
  • Medical Director Clinical PBM Operations

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$188,204 - $272,896 - $357,587 “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 The Medical Director provides enterprise-level clinical leadership across all pharmacy benefit management (PBM) operations at MedImpact. This role is responsible for ensuring clinical integrity, regulatory compliance, and operational excellence in formulary management, P&T governance, utilization management, drug information, appeals & grievances, quality, and accreditation. As a strategic physician leader, the Medical Director bridges clinical evidence, regulatory standards, and business strategy-ensuring that MedImpact delivers high-value, member-centered, and client-aligned pharmacy solutions that differentiates MedImpact. Essential Duties and Responsibilities include the following. Other duties may be assigned. Strategic & Clinical Leadership Serve as the clinical leader and subject matter expert across the PBM enterprise, advising executive and operational leadership. Lead the development of MedImpact's clinical governance framework for formulary, P&T, and utilization management. Partner with the Chief Medical Officer and Vice President, Clinical Operations, and cross-functional teams to align clinical strategy with client outcomes, cost of care, and quality metrics. Lead and mentor a team of clinical professionals, promoting a culture of integrity, innovation, and accountability. Represent MedImpact in client meetings, industry panels, and clinical advisory boards, strengthening the company's thought leadership in value-based PBM solutions. Formulary Management & P&T Governance Chair or serve as executive medical liaison for the Pharmacy & Therapeutics (P&T) Committee, ensuring evidence-based formulary decisions. Oversee drug monographs, class reviews, and pipeline drug assessments to inform coverage strategy. Direct the creation and review of prior authorization, step therapy, and quantity limit criteria, balancing access, safety, and cost containment. Provide clinical guidance on pipeline therapies, biosimilars, GLP-1s, specialty drugs, and gene therapies, aligning with enterprise strategy. Clinical Operations & Drug Information Oversee drug information and clinical policy functions, ensuring accuracy, timeliness, and defensibility of all clinical communications. Provide executive oversight of clinical programs such as medication therapy management, adherence interventions, and real-world outcomes measurement. Collaborate with Data & Analytics to evaluate the clinical ROI and health outcomes of formulary and utilization management programs. Appeals, Grievances & Medical Review Lead oversight for coverage determinations, exceptions, and appeals, ensuring adherence to CMS, state, and accreditation standards. Implement peer review, inter-rater reliability, and quality audit protocols across all adjudication functions. Support clinical staff with escalated or complex medical reviews and ensure consistency in decisions across the organization. Quality, Accreditation & Compliance Drive URAC, NCQA, and CMS accreditation readiness for all clinical departments. Lead clinical quality assurance programs, audit preparedness, and ongoing compliance monitoring. Define and report on clinical KPIs, including overturn rates, audit outcomes, safety events, adherence improvements, and client satisfaction. Cross-Functional Collaboration & Innovation Partner with Operations, Product, and Innovation to ensure clinical programs are operationally executable and technologically enabled. Collaborate with Client Success, Sales, and Marketing to provide clinical expertise in RFP responses, client renewals, and strategic presentations. Engage externally with providers, consultants, and regulatory agencies to maintain MedImpact's leadership in evidence-based pharmacy care. Supervisory Responsibilities Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Doctor of Medicine (MD) or Osteopathy (DO) degree from an accredited medical education program. Internship and Residency from an accredited program. Board Certified in an accredited medical specialty by the American Board of Medical Specialties or equivalent accrediting body. Primary care board certification is preferred. At least five years of direct patient care in a medical practice setting, either individual or group, along with minimum of 3-5 years of serving as a medical director in an HMO, medical group practice or PBM environment. plus 12 years' related experience; 10 years of SME in respective area(s); (or equivalent combination of education and experience); and 10 years supervisory experience; Supervisory experience may be substituted with 12 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader at the Director level or above that must be completed within 12 months in new position. Preferred Experience Prior leadership within a national PBM (CVS, Express Scripts, OptumRx) or large health plan. Experience with specialty pharmacy, GLP-1 utilization strategies, and value-based contracting Computer Skills Thorough knowledge of Microsoft Office, with emphasis on Word, Excel, Access, PowerPoint, Outlook, and Visio. Experience with Business Intelligence, Business Process Management, and Business Rules Management software. To perform this job successfully, an individual must also gain a thorough understanding of MedImpact proprietary software tools related to formulary administration, pharmacy claims adjudication, and drug data management. Certificates, Licenses, Registrations Current valid, unrestricted medical license, preferably in State of California, but in any state. Must be licensed in states where statues require licensure to perform services. Must maintain licensure, certification, and continuing medical education requirements in chosen field of medicine at all times. Other Skills and Abilities Proven leadership in formulary governance, utilization management, drug information, or medical review. Deep understanding of evidence-based medicine, pharmacoeconomics, and clinical policy development. Strong knowledge of URAC/NCQA/CMS requirements, regulatory compliance, and appeals/grievance workflows. Excellent communication, stakeholder management, and executive presentation skills. Reasoning Ability Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Mathematical Skills Ability to comprehend and apply principles of advanced calculus, modern algebra, and advanced statistical theory. Ability to apply advanced mathematical concepts such as exponents, logarithms, quadratic equations, and permutations. Language Skills Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Business Acumen Directing Others Organizational Agility Conflict Management Drive for Results Political Savvy Customer Focus Innovation Management Strategic Agility Decision Quality Managerial Courage 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. Visual acuity to 20 inches. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. 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 reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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 25% of the time. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $188.2k-272.9k yearly Auto-Apply 36d ago
  • Formulary Admin Specialist I

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Non-Exempt)$22.99 - $30.35 - $37.71 “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 Essential Duties and Responsibilities include the following. Other duties may be assigned. Weekly Drug Updates for Commercial clients Reviews weekly drug update projects, participate and assist in weekly formulary maintenance Attends Client meetings Monitors/updates Drug Rules and Auto coding rules per client requests Researches and responds to client inquiries; escalates to managers/pharmacists for complex issues Weekly Drug Updates for Medicare Part D formularies. Reviews weekly drug update projects, and participate and assist in weekly formulary maintenance Researches and responds to client inquiries; escalates to managers/pharmacists for complex issues Formulary mailbox and salesforce cases management Triages inquiries; serves as a resource for troubleshooting basic issues; escalates to managers/pharmacists for complex issues Drafts client communication to be reviewed by management; customizes templates with client instructions including clarification of roles/ responsibilities between MedImpact and the client; prepares routine client responses to email and salesforce case queries. Monthly and Pre-Plan Year ASCII Submissions Uploads CMS status tracking and responses, updates version numbers within Formulary Service's database Processes and distributes formulary ASCII submissions files to clients Uploads ASCII files to Health Plan Management System (HPMS)for standard formularies collaborating with the assigned pharmacist; Negative Formulary Changes Process Enters negative formulary changes request into formulary platform tool for standard formularies; Uploads and submits negative changes request into HPMS for Standard formularies; Processes and performs quality control for “Future Formulary Change Files” and distribute to clients for website posting; Formulary Pre-plan Year Process Reviews with the client the Formulary Implementation Questionnaire (IQ) and clarifies any questions/issues; Builds the formulary framework based on the client's implementation questionnaire for review by pharmacists; Prepare basic formulary parameters (rules) into the spreadsheet, this includes “temporary” or “special coding”; Provides audit support for claims analysis and sending client communications Performs Prior Authorization (PA) processing as needed during times of staffing shortages or absences. Works to gain a solid understanding of Formulary and PBM operations through on-the-job training, in-house educational opportunities and related external seminars or coursework. Supervisory Responsibilities This job has 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: Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients; Manage difficult client situations. 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 Associate's degree or Certified Pharmacy Technician CPT (or equivalent combination of education and experience required). Bachelor's degree preferred. At least 1+ year pharmacy (or) 1+ year PBM industry experience working with Medicare Part D and Prior Authorization. Computer Skills To perform this job successfully, an individual should have a good working knowledge of Microsoft Office Suite (Word/Excel/Outlook) and good familiarity working with databases. Certificates, Licenses, Registrations Current Pharmacy Technician License and/or CPhT certification without restriction preferred. Other Skills and Abilities Basic PBM knowledge, Drug Information and Prior Authorization experience preferred; Familiarity with National Drug Data Provider products a plus; Medicare Part D formulary knowledge desired; Good written/verbal communication skills; good interpersonal skills as well as the ability to work cohesively with a team; Must be able to juggle multiple priorities; follow through to completion on all tasks and be detail oriented; 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. Mathematical Skills Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, ratios, area, circumference, and volume. Ability to apply concepts of basic algebra. Language Skills Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively to customers and employees of organization. Competencies To perform the job successfully, an individual should demonstrate the following competencies: 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 frequently required to use hands to finger, handle, or feel. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. 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. 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. The noise level in the work environment is usually moderate. Working Hours This is a non-exempt position requiring one to be able to work overtime occasionally 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $37.7 hourly Auto-Apply 5d ago
  • Accreditation, Quality & URL Specialist

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$68,571 - $93,600 - $118,628 “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 Responsible for the execution of the annual accreditation and UR assessment process and work plan to maintain MedImpact accreditation and state UR licensure requirements. Coordinates with internal partners to accomplish assigned accreditation and compliance activities. Essential Duties and Responsibilities include the following. Other duties may be assigned. Performs accreditation and quality management related audits and activities with an emphasis on obtaining or maintaining accreditation and UR licensure. Participates in onsite audits/reviews, agency inquiries, and training employees, as needed. Performs ongoing monitoring to ensure the organization is meeting accreditation standards. Analyzes data, workflows, policies and procedures to assess program effectiveness. Interprets significance of routine-intermediate findings to identify areas of improvement, make and implement recommendations for improvement. Defines and documents accreditation and compliance process steps (i.e., policy and procedures) in accordance with current state, federal, and independent accreditation and UR licensing requirements. Communicates and consults with internal partners to assist with the implementation of accreditation and compliance recommendations for assigned area(s). Serves as accreditation subject-matter expert for all or specific program sections, to consult and update internal partners on accreditation efforts and requirements. May recommend and provide training to employees regarding accreditation and compliance requirements and procedures. Stays current with accreditation and regulatory requirements, as well as PA/UM programs in an effort to consult and provide a mutually beneficial resolution. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BS/BA and 5+ years' experience or equivalent combination of education and experience, and 3 years of SME in respective areas Computer Skills To perform this job successfully, an individual should have intermediate working knowledge of Microsoft Office Suite (Word/Excel/Access/Outlook) and Adobe Acrobat. Certificates, Licenses, Registrations Based on the clinical nature of the work, unencumbered healthcare related license is required. Examples of applicable licenses include Pharmacy Technician (CPT), Medical Assistant (MA), and/or Registered Nurse (RN). Other Skills and Abilities Experience managing operational projects from inception to completion as well as team leadership and facilitation responsibilities; Ability to gather requirements as well as prepare and maintain detailed product/project plans to support accreditation and quality management activities; Good interpersonal skills with the ability to work independently and as part of a cohesive team; Ability to work in a dynamic environment with constantly changing deliverables; 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. 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. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. 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. 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 reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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 no travel; however attendance may be 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $68.6k-93.6k yearly Auto-Apply 57d ago
  • Data Scientist V

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$131,188 - $183,664 - $236,139 “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 Essential Duties and Responsibilities include the following. Other duties may be assigned. Work with Application Development & Support teams as a data science and AI subject matter expert and architect to develop scalable AI solutions. Design and develop predictive and prescriptive analytics for various use cases, such as drug spend forecasting, insurance plan performance optimization, medication fraud/waste/abuse detection and prevention, preventive care, and personalized treatment planning. Fine-tune and customize LLMs to simplify manual processes in healthcare systems, e.g., prior authorization rule extraction from guideline documents, data exchange file checking and error handling. Collaborate with domain experts to validate results and model performance. Design, develop, and test code at all layers to make AI systems work end to end. Create and maintain system design document. Deploy and integrate AI systems into production environment. Build and maintain workflow frameworks that ensure AI performance monitoring and automated feedback loop for continuous improvement. Initiate and drive projects to completion independently, assuming full responsibility and end-to-end accountability for end-product delivery. Promote and enable adoption of technical advancements in Data Science; elevate the art of Data Science practice at MedImpact. Act as a thought partner to senior leaders to prioritize and scope projects, provide recommendations and evangelize data-driven business decisions in support of strategic goals. Partner with cross-functional teams to initiate, lead or contribute to large scale strategic projects for team, department, and company. Provide technical guidance and mentorship to less-experienced team members on solution design as well as lead code/design reviews. Education and/or Experience BS/BA and 10+ years' experience or equivalent combination of education and experience, and 6 years of SME in respective areas 3+ years of experience in a technical leadership role leading data science and AI engineering teams. Proven track record of leading AI solutions from ideation to implementation, production, and value realization. 2+ years of experience in developing predictive and prescriptive analytics in pharmacy benefit management for various use cases, such as drug spend forecasting, health benefit plan performance optimization, and medication fraud/waste/abuse detection and prevention. Familiarity with healthcare data and systems. Knowledge of prior authorization and pharmacy benefit adjudication processes. Extensive experience with databases, SQL, and programming languages like Python or Java. Thorough knowledge of data science methodology, software development life cycle, and agile development best practices. Deep understanding of AI/ML/NLP principles, specifically with generative models. Proficiency with deep learning frameworks such as Pytorch, TensorFlow, MLP, Large Language Models, Generative AI, LangChain, HuggingFace. Strong understanding and exposure in Gen AI like transformers, LLMs, text embeddings. Experience with AI automation platforms. Knowledge of reinforcement learning in addition to supervised and unsupervised machine learning paradigms. Excellent problem-solving skills, with the ability to think critically and creatively to develop innovative AI solutions. Strong communication skills, with the ability to effectively convey complex technical concepts to a diverse audience. Proven ability to prioritize and plan multiple projects to ensure effective delivery on time and budget. Business acumen, understanding business implications of decisions, demonstrating knowledge of market and competition, and aligning work with strategic goals Reasoning Ability Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Ability to define problems, collect data, establish facts, and draw valid conclusions. Mathematical Skills Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis. Language Skills Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. . Ability to read, analyze, and interpret the most complex documents. Work Location - Onsite - San Diego 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $131.2k-183.7k yearly Auto-Apply 60d+ ago
  • Manager, Digital and Market Intelligence

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$115,142 - $161,200 - $207,257 “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 This position is accountable for strategic and operational oversight of key MedImpact enterprise business solutions and market intelligence. Key focus areas will be on consumer/ member application performance and utilization, ensuring intended business values are well understood and realized. As the subject matter expert, this position requires technical knowledge of the applications design and implementation to support business and system process changes to drive peak performance and customer satisfaction. Relies on experience, judgment, business applications & systems knowledge, and technical skill to plan and accomplish goals. Essential Duties and Responsibilities include the following. Other duties may be assigned. Primary responsibility for gaining market, customer and user needs with respect to digital tools and MedImpact product assets. Acts as the Voice of Customer and the “face of digital marketing” to the market. Works with cross-functional teams including Senior Leadership to develop, execute and manage strategic plans, web solution roadmaps and customer experience strategy. Responsible for developing digital strategy based on Voice of Customer (VoC), competitive analysis and web analytics to ensure MedImpact has a viable web solution portfolio. Develops and maintains digital solution roadmaps for all web assets including web sites, mobile applications, portals and tools. Leads development and execution of omni-channel communications strategy and works cross-functionally to develop and align the company's digital communication capabilities. Leads, develops and implements digital marketing plans to support demand generation, sales enablement, consumer engagement, Responsible for developing consumer journey maps, customer experience strategy and implementation of business process changes required to execute that strategy. Responsible for implementing analytics and measurement capabilities and for reporting key web metrics. Stays current with PBM and healthcare industry trends to integrate into the above referenced deliverables. Gathers and documents business requirements and may drive the prioritization of application changes; Serves as liaison with the Information Technology group to resolve issues, and guide development; Participates in cross-functional teams to provide input into application modifications and development of new product features based upon customer/user input, and technology directions; Monitors the overall development schedule and partners with the IT Project Manager to ensure on time delivery of software releases; Provides product and system demonstrations to prospective and existing clients and acts as an SME in answering questions and highlighting key system capabilities; Collaborates with business partners to agree on functional specifications and operational readiness criteria; Achieves service commitments, including sustainable, measurable, accurate, reliable, and timely execution of service deliverables. Operates to high standards and develop new ideas for improving organizational performance; Partners with other MedImpact business units to effectively resolve customer issues and inquiries, implement new business, design solutions that meet the mutual needs of MedImpact and our customers. Actively participates as a key member of cross functional workgroups, teams, and committees as assigned; Promotes and engages in continuous improvement by developing and documenting business processes and measuring results. Identifies and leads the improvement opportunities in assigned work groups and business processes. Seeks out and actively participates in business initiatives that contribute to service excellence; Utilizes planning, prioritizing, and organizational skills to effectively manage the assets, tools, and processes necessary to achieve business objectives. Provides recommendations for the acquisition/development or enhancement of equipment and systems necessary to support the business in an efficient and quality manner. Supervisory Responsibilities Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BS/BA degree or equivalent plus 5+ years of experience; 1 year of SME in respective area(s); and 3+ years of supervisory experience; 4 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (Dir+) that must completed within 12 months in new position may substitute for the supervisory experience requirement. Computer Skills Strong proficiency with MS Office / Word, PowerPoint, Excel, Visio and Outlook to create complex documents, manage schedules, and analyze data. Working knowledge of key business application such as SQL coding, Oracle forms, Golden 32, MedAccess, MedOptimize, SalesForce, and UNIX operating systems. Certificates, Licenses, Registrations None required Other Skills and Abilities Ability to effectively recognize complex problems and apply analytic and critical thinking skills to innovate solutions. Ability to exercise sound judgment and decision-making. Ability to collaborate on cross-functional projects and liaise with stakeholders on both the business and IT divisions of the organization. Demonstrated ability to positively interact with clients, and staff of all levels, a willingness to take accountability for achieving service commitments and a demonstrated ability to achieve results. Demonstrates ability to 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. Reasoning Ability Ability to apply common sense understanding to carry out simple one- or two-step instructions. Ability to deal with standardized situations with only occasional or no variables. Mathematical Skills Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis. Language Skills Ability to effectively present information to top management, public groups, and/or boards of directors. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Building Effective Teams Decision Quality Informing Confronting Direct Reports Delegation Organizational Agility Customer Focus Drive for Results 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. 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). Working Hours This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $115.1k-161.2k yearly Auto-Apply 45d ago
  • Drug Data Classification & Maintenance Pharmacist

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$108,515 - $152,464 - $196,412 “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 The Drug Classification & Maintenance Pharmacist participates in the development and maintenance of Core Formulary Processes focusing on the Formulary Maintenance Weekly Drug Update activities including Proxy and CUI maintenance related to the Part D MedImpact Standard and Custom formularies and other functions as required Essential Duties and Responsibilities include the following. Other duties may be assigned. • Principal SME Pharmacist on CMS Part D drug eligibility and placement. Maintains and oversees appropriate Part D assignment and CUI mappings of drugs consistent within utilization management groupings of drugs. Reviews new drug categorization changes to customize, implement, and integrate with MedImpact formulary products as appropriate. Monitors drug vendor and regulatory bodies for operational or strategic market changes. Collaborates with the MedImpact National Drug Data File (NDDF) Team as well as MedImpact Drug Information Services to ensure success. • Performs complex data analytics based upon external drug data provided to MedImpact by FDB, MediSpan, RXNorm and CMS FRF. • Acts as a clinical and analytical subject matter expert on areas pertaining to Part D drug mapping and classification and supports development and implementation of mapping and PPDL programs. • Responsible for interpretation and implementation of CMS guidance related to each of the Part D PPDL drug lists. Maintains Formulary Services' CMS Part D Pre-Processing Drug Lists (PPDL) which include weekly review and yearly update CMS_PPDL Drug Lists: The accurate maintenance of lists is essential to CMS Part D compliance and accurate claim adjudication. • Processes the monthly / yearly CMS FRF and NIH's RxNorm drug update files to ensure accurate and compliant file submission to CMS. • Serves as Drug Data Management's designated contact for communication to NIH's RxNorm for general inquiries and data correction requests. • Masters a variety of analytical and quality control tools to ensure formulary drug data accuracy and integrity. Simultaneously engages in the activities and timelines for multiple CMS Plan years with differing and sometimes conflicting rules and regulations. • Contributes to and assists with current Drug Data Management and formulary enterprise priority projects, programs, or initiatives as defined by leadership. Coordinates inter- and intradepartmental project activities and groups as necessary to meet project goals and timeframes. • Provides internal consultation on CMS statutory regulations specific to Part D eligibility status and Part D related GPS programs PPDL drug lists. • Executes within the confines and timeframes provided by CMS which may include non-standard business hours. • Collaborate with MedImpact's Health Services advisors, Formulary Administration Pharmacists, IT partners, NDDF (FDB / MediSpan), Drug Information, Configuration Services team to ensure accurate drug mapping and classifications contents abide by Part D guidance. • Ensures that the mapping and classification changes occur in an appropriate, accurate, and timely manner based on drug data and Part D guidance. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. 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 must have solid computer skills including Microsoft Office (Word/Excel), MS Outlook and familiarity with industry standard databases. Understand, create and execute basic SQL queries and relational databases Certificates, Licenses, Registrations Valid Registered Pharmacist license in the State of California or equivalent state Other Skills and Abilities Prior experience with Medicare Part D and CMS formulary submission and maintenance processes highly desirable. Operates with flexibility in a changing business and government regulated environment. Must be able to execute and deliver within the confines and timeframes provided by CMS which may include non-standard business hours. Must be able to establish a good working knowledge of MedImpact clients and operational departments and have ability to bridge departmental boundaries Prior experience in PBM formulary setup and maintenance, relational and analytical database management programs, as well as, familiarity with First Databank, Medi-Span and RxNorm drug files preferred. Assists in the development and promotion of the business unit's vision, goals, and objectives in support of the Company's overall objectives; Develop and further extend MedImpact's efficiency and accuracy of Formulary Enterprise applications, Part D drug lists, and government programs. Participates and supports audit processes as a clinical subject matter expert; provides necessary information, documentation and analysis required by audits; support departmental and corporate development of audit support infrastructure Provides direct consultation on drug mapping and classification maintenance operations, programs, and software for multiple line(s) of business managed within MedImpact's formulary management software. Support colleagues in a range of accountabilities by being versed in cross-functional operations within the department Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Mathematical Skills Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. 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. 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 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 an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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 no travel; however attendance may be 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $108.5k-152.5k yearly Auto-Apply 31d ago
  • Rebate Payment Analyst I

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$52,693 - $69,160 - $85,626 “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 The Rebate Payment Analyst is responsible for accurately calculating and reporting on client rebate payments within assigned book of business. This position maintains a high level of accuracy in analysis while meeting reporting and all other deadlines each month. The position will interact with internal stakeholders to support our customers. Essential Duties and Responsibilities include the following. Other duties may be assigned. Responsible for understanding and interpreting client contract payment terms for assigned segments of rebate payments and reporting; ensures rebate requirements are coded into rebate database application accurately. Ability to analyze large data sets to identify trends, opportunities and troubleshoot issues which may arise when calculating client rebate payments. Prepare client rebate reporting for assigned book of business, ensuring accuracy and completeness while adhering to Medimpacts Standards and client contract terms. Maintains and adheres to the policies & procedures of all processes pertaining to rebate guarantee management, rebate allocation and rebate payments. Reviews client rebate questions with internal stakeholders regarding client rebate deliverables and addresses any issues. This position requires a basic level expertise of SQL, including modifying queries and the ability to understand and interpret complex data sets to accurately support the payment process. Continuous improvement mindset, always looking for new ways to best meet internal and external requirements. Demonstrated ability to manage multiple priorities and deadlines. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BS/BA and 2+ years' experience or equivalent combination of education and experience Computer Skills To perform this job successfully, an individual should have strong knowledge of Microsoft Office Suite software including Word, Excel, and Access. Basic SQL experience required. Certificates, Licenses, Registrations None required Other Skills and Abilities Excellent communication skills (both verbal and written), analytical and financial reasoning skills. Experience in accounting, finance, or data analysis. Demonstrated attention to detail. Understanding of PBMs or managed healthcare experience is a plus. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to define problems, collect data, establish facts, and draw valid conclusions. 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 read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. 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. 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. 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 reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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 may require domestic travel. This position requires domestic travel of less than 10% of the time. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $52.7k-69.2k yearly Auto-Apply 17d ago
  • Project Manager

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$71,614 - $95,784 - $119,953 “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 The Project Manager will use the industry's best practices for project management along with a solid working knowledge of the project management life cycle, the Project Manager plans, directs, and coordinates Account Management projects to ensure that project goals are accomplished within prescribed time frames. The position is responsible for ensuring project goals and requirements are met on schedule, within budget and are successfully completed. The Project Manager adheres and adapts to current processes. Identifies and recommends improvements to current practices. Handles escalated issues and demonstrates appropriate escalation of issues as needed. Leads major Client projects and may handle some projects internal to Account Management as assigned. Works independently, relies on experience, judgment, business applications & systems knowledge, and technical skill to plan and accomplish goals. A wide degree of creativity and latitude is expected. Lead and direct the work of others related to projects Essential Duties and Responsibilities include the following. Other duties may be assigned. Initiation Defines project objectives/goals; determines the scope of each project as well as the project charter. Coordinates with key project personnel for requirements, technical analysis, design, and documentation of solutions to meet business requirements and drive technical problem resolution. Planning/Development Develops and coordinates the project plan by identifying project deliverables, milestones, scheduling, and required tasks. Uses planning and analytical skills in support of requirements gathering, writing functional specifications, understanding current system functionality and processes, and test plan development activities. Helps ensure solution design meets client requirements and MedImpact standards. Working with stakeholders and Resource Managers, determines staffing requirements and allotment of available resources to each project phase. Works with assigned project staff and/or clients to gather and document project requirements. Communicates with project team to outline work plan, assign duties, responsibilities, and scope of authority. Ensures that all responsibilities are clearly communicated, from requirements gathering to working with testing teams to ensure solid quality assurance plan. Production/Execution Manages the day-to-day operational aspects of a project and scope by tracking to the project plan. Effectively sets and manages client expectations by establishing a positive and productive working relationship with clients. Defining, understanding, and taking into account cross-project dependencies and their impact to the individual projects as it relates to the system, resources, and time frames. Facilitates regular project status meetings to assess progress versus milestones, and identify areas of potential concern in adequate time in order to mitigate risk. Tracks projects and issues closely, fosters collaboration from both the client and internal groups and leads issue resolution meetings during projects. Manages risks throughout the project by identifying, communicating, tracking and mitigating. Meets with project personnel to provide technical advice and to resolve problems. Ensures all follow-up action items are owned and closed out by the relevant owners Monitors/Controls Manages and monitors project status by establishing a regular meeting schedule with project teams. Directs and coordinates activities of project personnel to ensure project progress is on schedule and outstanding items or issues are successfully resolved. Creates and communicates regular status reports for management, clients and the project team. Provides formal and ad-hoc updates to management as required. Prepares project status reports and keeps clients and others informed of project status and related issues. Ensures completeness of all project documentation throughout the project lifecycle and for obtaining appropriate approvals at each phase of the project. Participates in reviewing, monitoring, and gaining appropriate approvals for project documentation throughout the project lifecycle including: Vision and Scope, Functional Specifications, Architecture Specifications and Objectives of the Project. Ensures completeness of all project documentation throughout the project lifecycle and for obtaining appropriate approvals at each phase of the project. Closing/Post Release Activities Assumes responsibility for delivery by ensuring all components of the project are successfully completed. Determines downstream impacts and creates/executes the deployment plan. Manages and monitors issues generated by projects after “go-live” during the rollout and maintenance period. Identifies training needs for Clients, Business users, Contact Center as well as Operations personnel. Coordinates configuration management and deployment of the project. Interfaces with other departments for project transition. Other Builds and maintains good working relationships with project client, team members and other departments. Mentors Account Mangers in project management methodologies. 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 5+ years' experience or equivalent combination of education and experience, and 2 years' of SME in respective areas Computer Skills Proficient with Microsoft Office (Word/Excel/PowerPoint), MS Outlook and MS Project. Must be proficient with Project Scheduling Software such as MS Project and Smartsheets. Familiarity with MedImpact developed applications helpful (MedAccess, MedResponse, etc.) Certificates, Licenses, Registrations None required; PMP certification is highly desired. Other Skills and Abilities · Must have good negotiation skills, well-developed facilitation and collaboration skills · Proven leader and team player · Strong client management skills · Ability to work in a matrix management organization · Driven and committed to overcome obstacles and deliver the project on time · Delivery-focused, yet flexible and creative when called upon Reasoning Ability · Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. · Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. 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 read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. · Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. 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 (or other company location) 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. Periodic scheduled remote work may be permitted as allowed under the department's policy and with management approval. 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 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $71.6k-95.8k yearly Auto-Apply 23d ago
  • Software Eng IV

    Medimpact 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$110,982 - $155,376 - $199,769 “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 The Software Engineer IV works within the Application Development & Support team to provide complex software programming for new software, production support and maintenance for existing software, as well as ad-hoc support of key departmental initiatives which drive business functions. This Software Engineer IV receives general instructions on new projects and works autonomously to complete deliverables. Essential Duties and Responsibilities include the following. Other duties may be assigned. Develops software at all layers by programming, designing and testing code to meet requirements. Gains a thorough understanding of functional requirements for new software requests. Works with Business Systems Analysts to understand and clarify software requirements and translate into working software. Practices good software engineering techniques and standards to reduce coding errors and ensures robustness and efficiency of work products. Partners with software teams in the development of the software engineering processes. Works to identify and resolves technical or product problems. Participates in software project meetings and provides status reports. Translates technical designs into working software. Maintains existing applications by enhancing software and troubleshooting issues. Collaborates with team members and partners with others as needed to ensure successful completion of assigned software development tasks. Participates in code reviews and incorporates recommendations. Applies Object Oriented Design principles and design patterns in creating System level solution designs. Creates and maintains software design specifications document. Assumes full responsibility for assigned tasks and end-to-end accountability for end-product delivery. Makes recommendations to IT management for the adoption of (1) new technology (2) industry's best practices, and (3) streamlining processes. Communicates and presents designs in group settings to technical and non-technical audiences. Partners with team members and technical project lead to ensure component design fits in with the overall solution. Adopts new techniques and technologies. Initiates attendance at job related training to keep skills current. Maintains current understanding of the industry's best practices. Assists with mentoring and training of less experienced IT staff members. 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 8+ years' experience or equivalent combination of education and experience, and 4 years' of SME in respective areas Computer Skills Excellent working knowledge of a variety of currently used programming languages such as Strong working knowledge of multiple programming languages, including Java, Python, SQL/PL SQL Proficient in databases such as Oracle RDBMS and MongoDB Experienced in UI front-end development tools and frameworks, including Angular and React.js Skilled in working across UNIX and Windows environments Expertise in Object-Oriented Analysis and Design (OOAD) Proficient in web application frameworks such as Django, Flask, and FastAPI Experience with tools and frameworks including JPA with Hibernate, Spring Boot, and XML Well-versed in Agile methodologies, with experience in requirements gathering and creating flow diagrams Hands-on experience with Docker and Kubernetes for application deployment Certificates, Licenses, Registrations None required. Other Skills and Abilities Demonstrated ability to work collaboratively on project teams and/or matrix-managed teams. Ability to appropriately schedule and prioritize multiple projects to ensure timely and effective delivery of IT solutions. Excellent written and verbal communications skills with emphasis on translating technical concepts to non-technical audiences. Results oriented and ability to juggle multiple concurrent projects with changing priorities and deadlines Familiarity with PBM business model (plans, programs, and practices) as well as pharmaceutical practices (nomenclature, medications) helpful Reasoning Ability - Choose up to 1 from each drop-down list. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Mathematical Skills - Choose up to 1 from each drop-down list. Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply advanced mathematical concepts such as exponents, logarithms, quadratic equations, and permutations. Language Skills - Choose up to 1 from each drop-down list. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. 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 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 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $111k-155.4k yearly Auto-Apply 60d+ ago
  • Director, Business Intelligence & Reporting Platform

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$130,148 - $182,208 - $234,267 “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 The Director, Business Intelligence (BI) and Reporting Platform is a pivotal leadership role responsible for defining and executing the organization's data delivery strategy to drive operational efficiency and client value. The Director will lead the BI function, ensuring all analytics, reporting, visualization tools and platform are secure, accurate, and aligned with strategic business outcomes. This role balances team leadership, platform governance, and continuous alignment with internal business and clinical partners and external customers, while also leading the integration of multiple BI teams into a single cohesive unit. Crucially, the Director will iterate and deliver on the MedImpact BI Reporting vision, evolving standard reports into advanced analytics, including predictive and prescriptive modeling and AI integration, to provide deep, strategic insights and actionable recommendations to internal and external customers Essential Duties and Responsibilities include the following. Other duties may be assigned. Strategic Leadership & Business Alignment Own the BI Reporting Vision: Iterate, prioritize, and communicate the multi-year One Reporting roadmap, ensuring all development efforts move beyond standard reporting to include predictive analytics, prescriptive recommendations, and AI third party data integration. Drive Strategic Outcomes: Spearhead the delivery of advanced analytics capabilities (such as utilization trend forecasting, benefit and network optimization simulations, identification of non-adherence risks), and fraud waste and abuse identification that provide actionable recommendations to address identified clinical and savings opportunities. Executive Advocacy: Serve as the primary IT liaison for BI, presenting insights and roadmaps to senior leadership and key business partners (Finance, Claims, Client Services, and Clinical Analytics). Secure the necessary CapEx and OpEx funding for platform evolution and maintenance and team growth. Data Governance & Quality: Chair or actively participate in the Data Governance Committee to establish and enforce enterprise-wide standards for data definitions, security, and quality assurance, ensuring reports drive accurate business outcomes. Client & Stakeholder Management: Translate complex business requirements into technical BI deliverables, ensuring that all reporting adheres to external client needs and regulatory standards (e.g., HIPAA, CMS, WCAG). Platform Management & Architectural Governance Platform Oversight: Direct the design and maintenance of the BI reporting architecture, ensuring the platform achieves high availability, scalability, and optimal integration with underlying data sources. Project Leadership: Oversee significant technical projects, including the planned transition from multiple legacy platforms to a single environment, focusing on project timelines, risk mitigation and internal and external change management. AI Integration: Partner with the AI and platform teams in building out the infrastructure and APIs necessary to integrate in-house built AI models and external data science tools into the reporting platform environment, supporting AI-guided data analysis and dashboard creation. Security & Compliance: Oversee the implementation of security protocols (RBAC, data masking, encryption) within the BI environment to meet all internal policies and external compliance requirements. Team Management & Operational Excellence Team Integration & Morale: Champion the cultural integration of consolidated BI reporting teams and technologies into a single, cohesive unit. Proactively manage team morale, resolve conflicts, and foster a unified culture of data excellence throughout the platform deployment. Team Leadership: Lead and mentor a specialized team including BI Developers, BI Platform Administrators, and Analytics & Reporting Specialists. Establish clear roles and responsibilities to separate development work from platform maintenance. Operational Governance: Implement and enforce a structured process for the report lifecycle, including promotion from Sandbox to User Acceptance Testing and final deployment to Production. Performance Optimization: Oversee the administration team's efforts in capacity planning, load balancing, and server tuning to ensure the BI platform delivers high performance. Talent Strategy: Champion the recruitment and development of technical staff proficient in advanced analytics and AI model consumption, ensuring the team can translate member, clinical, and claims data into quantifiable opportunities that drive strategic business solutions. Supervisory Responsibilities Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BA/BS Degree or equivalent; plus 10 years' related experience; 10 years of SME in respective area(s); (or equivalent combination of education and experience); and 8 years supervisory experience; Supervisory experience may be substituted with 10 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader at the Director level or above that must be completed within 12 months in new position. Computer Skills Strong command of SQL and deep familiarity with data modeling concepts. Experience with BI platforms (e.g., Apache Superset, Cognos and Tableau) is highly desirable. Experience in integrating AI models into BI platform and reporting Certificates, Licenses, Registrations None required. Other Skills and Abilities Proven ability to build and deliver an advanced analytics roadmap that includes predictive, prescriptive, and AI capabilities, translating complex models into clear, actionable business recommendations. Demonstrated ability in change management to drive successful adoption of new technologies across a large organization, overcoming technical and cultural resistance. Proven ability to manage complex organizational change, merge diverse technical teams, and actively optimize team morale during periods of high-stress change or migration. Ability to discuss and make decisions regarding data pipelines, performance optimization, and server infrastructure with Infrastructure and DBA teams. Unwavering commitment to data quality, security, and regulatory compliance in a sensitive healthcare environment (PBM/HIPAA). Excellent written and verbal communication skills, with the ability to translate complex technical issues into clear business impact statements for executive leadership. Reasoning Ability Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to define problems, collect data, establish facts, and draw valid conclusions. 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. Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Business Acumen Directing Others Organizational Agility Conflict Management Drive for Results Political Savvy Customer Focus Innovation Management Strategic Agility Decision Quality Managerial Courage 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. 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 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 an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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 20% of the time. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $130.1k-182.2k yearly Auto-Apply 8d ago
  • Principal, Network Engineering

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$101,277 - $139,256 - $177,234 “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 The PBM business is a data-intensive business with much of MedImpact's value to its clients deriving from the careful organization, processing and availability of applications. As an integral part of the Information Technology Infrastructure group, the Principal, Network Engineering, plays a key, visible role within the MedImpact IT department and in support of Business Operations. The IT Principal, Network Engineering provides subject matter expertise at the highest technical level within the organization and is called upon to work on multiple concurrent special projects by understanding requirements, problems, performing root cause analysis, researching solutions and guiding IT owners in the implementation of solutions. Essential Duties and Responsibilities include the following. Other duties may be assigned. Provides individual contribution as well as technical leadership in the following areas: Identifying & translating ambiguous, unstated and understated business needs into holistic technical solutions Researches, identifies, plans, evangelizes and socializes appropriate new technologies and technical solutions with IT as well as with business stakeholders High-level as well as detailed design and specification of technical solutions Represents MedImpact IT as a technology subject-matter expert internally and externally (with clients & partners) as necessary Mentors and guides other technical personnel on technology, techniques and best-practices Assists in MedImpact IT recruitment efforts with candidate-interviews Identifies, documents and helps protect MedImpact intellectual property where appropriate Leads “matrixed” teams when necessary without formal supervisory authority within the context of a specific situation or a project. No permanent supervisory functions required Interfaces with clients to understand needs and concerns, suggests solutions and may manage sensitive customer-relationship situations with patience and maturity Suggests refinements to current or institutes new IT policies and procedures Creates, monitors, and maintains a robust company infrastructure that supports application availability and performance by responding internal and external customer requests and assignments from management. Provides data analysis and troubleshoots networking and application issues. Assists with related task planning, training and technical direction of other Network Engineers or IT engineers and developers. Provides technical leadership and advice for the company's use of networking and related technologies. Provides leadership and guidance on large, complex and cross functional projects and tasks. Researches and recommends current and trending network technologies that offer the organization ways to improve its level of service to customers and maintains its leading edge over competitors Assists in the resolution of application performance and availability issues by leveraging the network to provide relevant information to issue resolution. Provides network performance tuning and capacity planning services; leads conversions and upgrades. Develops documentation for the assessment and automation of repeatable processes. Drives the development of (and adherence to) network security standards, methods and practices. Assists in maintaining plans for disaster recovery and failover capabilities and testing. Maintains security according to company guidelines and works closely with the IT Security team to develop additional robust solutions. Documents findings and recommendations for use in decision making and further system design. Provides peer reviews for work produced by Network Engineers, Systems Engineers, and Application Support. Develops, documents, automates, and assesses network administration processes while looking for ways to improve current processes and streamline efforts. Trains others on the IT Network Engineering Team. Acts as a mentor to less experienced Networking staff and/or staff in other IT functions. 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BA/BS Degree;8+ years related experience and 8+ years of SME in respective area(s); (or equivalent combination of education and experience). Computer Skills Excellent working knowledge of a variety of networking technologies. Efficient troubleshooting skills Thorough knowledge of network communication protocols MedImpact's legacy systems knowledge (preferred) Hardware architecture, disk arrays, drives and hardware capacity requirements. Oracle relational database architecture, design and maintenance High-level proficiency with relevant software, operating systems, and related technologies such as: Windows, Linux, Checkpoint, Citrix Netscalers, Cisco ACI, and UNIX among others Experience with network design, development, and operational support Strong proficiency in supporting applications from the network perspective and diagnosing performance issues Solid working knowledge of current network technologies and application monitoring tools. Certificates, Licenses, Registrations CCIE, AWS/Azure, CompTIA Network+ Other Skills and Abilities Analytical-thinking, critical-reasoning, and problem-solving skills as applied to complex business technology subject areas Written, verbal and presentation skills to educate, inform and facilitate decision-making Planning and organization skills to conceive and execute small projects and work-efforts independently Demonstrate the ability to initiate and influence change by effectively collaborating with and managing both IT functional areas and business partners in a “matrixed” environment, leveraging informal authority to drive results Technical trouble-shooting and root-cause analysis skills in service-disruption scenarios Ability to work independently and as a cohesive team member with excellent interpersonal skills. Good verbal, written communication and presentation skills. Excellent organizational, attention to detail, and follow-up skills. Must be available for on-call work as needed. Reasoning Ability Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Mathematical Skills Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis. 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. Language Skills Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Business Acumen Directing Others Organizational Agility Conflict Management Drive for Results Political Savvy Customer Focus Innovation Management Strategic Agility Decision Quality Managerial Courage 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. 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 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 an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at 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. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $101.3k-139.3k yearly Auto-Apply 47d ago
  • Bilingual Provider Relations Contract Analyst (on-site in Puerto Rico)

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$60,987 - $80,808 - $100,628 “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 *The ideal candidate will be Bilingual English/Spanish and based in Puerto Rico* The Provider Relations Contract Analyst Puerto Rico is responsible for relationship management with pharmacies in support of plan sponsors, strategic initiatives and operational projects, pharmacy network contracting efforts and processes, and pharmacy network operations. Essential Duties and Responsibilities include the following. Other duties may be assigned. Regularly visit Puerto Rico pharmacies to forge a connection and build trust Work with pharmacies to provide education and support on pricing, credentialing, recredentialing, attestations, and any other network related activities Assist Account Management in client plan benefit and network preparation with area pharmacies Prepare, schedule, and present at quarterly pharmacy meetings Review pharmacy contract setup to ensure compliance with pharmacy network agreements Support pharmacy audits and network compliance initiatives Support daily credentialing, re-credentialing, and contracting operations Implement changes to ensure compliance with all company policies and procedures as well as regulatory requirements Research and problem solve to resolve claim issues and concerns Respond to and track requests, inquiries, and communications with network pharmacies Collaborate with cross-functional teams on pharmacy-related matters Develop, review and distribute pharmacy communications to meet internal and client requests Investigate specific issues related to regulatory requirements through literature or internet resources Resolve dissatisfaction among providers within limits of authority Maintain current provider data to ensure the quality of the network Run reports and support data analysis to produce meaningful and actionable results to answer key business questions Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures Track project tasks and deliverables to ensure timelines are met Collaborate with Implementation Managers on specific project assignments. Other duties may be assigned. 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 To perform this job successfully, an individual should have knowledge of SQL, Microsoft Access and Quest Analytics; Microsoft Office and Outlook. Other Skills and Abilities Working knowledge and understanding of Insurance, pharmacy and/or healthcare contracting and/or claims experience. Data query, data analysis and presentation skills Project coordination experience within a corporate environment coordinating multiple teams with constant deadlines and driving project processes. Strong written and in-person communication using clear, simple language that all stakeholders can understand. Previous experience working directly with customers and good presentation skills. Ability to work independently and support project / issue resolution. Previous experience as a pharmacy technician is preferred. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. 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 Candidate must be fluent in English and Spanish. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. 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 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 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 25% of the time. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $61k-80.8k yearly Auto-Apply 10d ago
  • Business Digital Solutions Manager

    Medimpact Healthcare Systems 4.8company rating

    San Diego, CA job

    Exemption Status:United States of America (Exempt)$85,356 - $115,232 - $145,107 “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 In this role, you will lead asset development and market entry initiatives related to our core platform ecosystem, empowering payors, providers, pharmacists and other external stakeholders. This role requires business process understanding, technical and product design expertise to deliver scalable, market leading, user centric digital solutions. The ideal candidate will have a proven track record in digital healthcare and a passion for digital transformation. Essential Duties and Responsibilities include the following. Other duties may be assigned. Maintain and execute the strategic vision and roadmap of our healthcare platform ecosystem Responsible for rapid prototyping and piloting emerging technologies to test viability before full-scale implementation Identify and execute product digitization, business process automation and asset integration opportunities to create scale, speed to market and a seamless end user experience Expand data visualization, predictive analytics, and reporting footprint across assets Propose continuous improvement opportunities based on platform and user analytics Contribute to the annual user satisfaction survey Act as a liaison between technology, UI/UX, clinical, business and operations teams to ensure on-time delivery of high-quality products and user experience Contribute to the go-to-market strategies, pricing, positioning and launch plans, in coordination with marketing communication, sales enablement and external agency teams Stay current with pharmacy benefit management, healthcare industry, digital health trends to incorporate learnings into product design and planning Model and cultivate behaviors that achieve business success, including collaboration, accountability, and ownership 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 7+ years' experience or equivalent combination of education and experience, and 4 years' of SME in respective areas Computer Skills Strong proficiency with MS Office / Word, PowerPoint, Excel, Visio and Outlook to create complex documents, manage schedules, and analyze data. Working knowledge of key business applications such as Figma, Google Analytics, Salesforce, and Jira, Confluence. Certificates, Licenses, Registrations None required; Product and Digital certifications are a plus Other Skills and Abilities Ability to effectively recognize complex problems and apply analytic and critical thinking skills to innovate solutions. Ability to exercise sound judgment and decision-making. Ability to collaborate on cross-functional projects and liaise with stakeholders on both the business and IT divisions of the organization. Demonstrated ability to positively interact with clients, and staff of all levels, a willingness to take accountability for achieving service commitments and a demonstrated ability to achieve results. Demonstrates ability to 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. Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Mathematical Skills Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information to top management, public groups, and/or boards of directors. 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 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 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. 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 ************************* 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. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/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.
    $85.4k-115.2k yearly Auto-Apply 60d+ ago

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