MedImpact Healthcare Systems jobs in San Diego, CA - 56 jobs
Technical Project Manager III, Medicaid, Fee-for-Service
Medimpact 4.8
Medimpact job in San Diego, CA
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 28d ago
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Formulary Admin Specialist I
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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.
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
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Manages Account Executive development of client-specific business plans focused on the client's goals, performance expectations, growth in membership and profitability. Ensures that deliverables are on time, within budget, and meet the quality levels expected by MedImpact's internal and external customers.
Provides direction and management over Key and LAMP Account Management teams to monitor the quality of products and services being offered to the client. Trains new staff members and provides on-going coaching to existing Account Management teams.
Optimizes potential for sustainable growth and profitability. Identifies and aligns required resources to achieve business goals in book-of-business.
Develop and maintain solid business relationships with region's clients at the executive and key decision-maker levels. Determines where to make “focused investments” for each account.
Utilizes financial and pricing models to analyze and present business and clinical scenarios to client illustrating different benefit strategies and advantages of adoption.
Researches and analyzes market trends and competitive practices to ensure client strategy is placed in context of client's industry and marketplace.
Monitors client service continuum including proactive and reactive components. Resolves escalated issues, while ensuring ongoing issues are resolved expeditiously. Performs 360o review of performance on account, from operational service delivery to relationship management. Identifies gaps and sources of corrective action to ensure milestones are met.
Collaborates with leaders in Operations, IT, Health Services and the other Directors.
Supervisory Responsibilities
Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of this 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
Bachelor's degree (Master's degree preferred) and a minimum of ten (10) years related experience and eight (8) years of SME in respective area(s); (or equivalent combination of education and experience) with at least eight (8) years leading individual contributors, leaders, and leaders of leaders; which may be substituted with an appropriate mix of leadership experience and 10 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (VP+ level) that must completed within 12 months in new position
Required experience depends on assigned book of business.
Self-Insured - Experience in the Self-Insured benefits arena, experience with health plans/white label required.
Location - Remote - Eastern or Central Region
Computer Skills
Intermediate to advanced computer skills; proficient with MS Office/Outlook and client databases
Certificates, Licenses, Registrations
None currently required.
Other Skills and Abilities:
Working knowledge of the health benefits arena, government prescription programs, preferably in pharmacy benefits management required; knowledge of healthcare products and contracts preferred; Consultative selling and negotiation skills; Demonstrated experience creating and delivering client presentations using; Strong verbal, written, interpersonal, presentation, persuasion and consulting skills required; Good interpersonal skills, excellent communication, writing and presentation skills essential;
Other Qualifications
Outstanding knowledge of the health benefits arena, preferably in pharmacy benefits management “PBM” or other managed healthcare services to national and regional managed care organizations, insurance companies, and other health related entities.
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, 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 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.
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 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 and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
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.
While performing the duties of this Job, the employee is occasionally exposed to moving mechanical parts; fumes or airborne particles and risk of electrical shock. 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 one to work the hours needed to get the job done. Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. This 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, often supporting multiple time zones depending on assigned book of business.
Travel
This position requires domestic travel of up to 50% of the time with little or no advance notice.
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 60d+ ago
Clinical Specialist
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 49d ago
Instructional Designer
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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
Essential Duties and Responsibilities include the following. Other duties may be assigned.
· The Instructional designer analyzes current needs, designs, develops, implements and evaluates the delivery of fundamental or baseline GPS training programs.
· In conjunction with the Instructional Designer II, determines instructional goals and objectives for each learning project. Where possible, assists in the analysis of the target audience's current state of knowledge, skills and any gaps to identify learning objectives and outcomes.
· Develops and evaluates a set of planned strategies targeted for attaining the project or learning outcomes and goals. Documents the projects instructional, visual and technical design strategy; create storyboards, designs the user interface and user experience; creates prototypes and applies visual or graphic design.
· Researches course matter by interviewing subject matter experts, consulting management/ industry experts and relevant domains of source material. Translates technical information so that it is understandable to a non-technical audience.
· Develops interactive training materials that include sound instructional design methodology including presentations, instructor and participant guides, classroom activities, practice exercises and handouts.
· Determines and implements the process for the delivery of training programs which may include training facilitators, conducting “Train the Trainer” sessions and/or directly training learners. Creates the course curriculum, learning objectives, as well as methods of delivery and testing procedures.
· Delivers training through a variety of presentation formats (e-learning, instructor led classroom style, individual or departmental meetings). Creates supporting material/media such as user guides, job aids, quizzes, audio, video, role plays, games and simulations, as well as exercises and activities to enhance the learning process.
· Produces and provides materials that serve to educate other internal departments about basic elements of Medicare and other programs currently in use at MedImpact.
· Promotes knowledge sharing and the efficient use of technology accessing relevant documentation, making communications accessible to employees through internal repositories such as Confluence, TMS (Learning Management System) and the intranet.
· Develops and delivers new hire training programs and other continuing education training designed for Medicare Programs Operations staff; monitors employee progress throughout the duration the training. Assists in the establishment and maintenance of new hire training, tracking milestones and providing assessments.
· Participates in ongoing self-development to ensure knowledge is current and proficiency in training skills remains high. Remains current on the latest instructional design concepts, reviewing existing standards and attending seminars and courses that assist in the adoption of new design methodology. Retains familiarity with learner and facilitator guide standards.
· Utilizing their understanding of Guidance within the context of Regulatory services, assists Management in the identification of and subsequent development of emerging training needs.
· Recommends training strategies and effective approaches to the leadership team for implementation on both a quarterly and annual basis.
· Assumes a lead role with subject matter experts, including Program Managers, Leads and Supervision to develop course content.
· Applies instructional design theories and methods, utilizing multimedia tools to enhance the learning process. This includes building training and technical manuals for use by clients utilizing both MedImpact and adjunct vendor systems.
· Recommends advanced software and new applications for utilization and adoption, supporting emerging products and revisions to existing programs.
· Condudts research in annual Guidance publications that include the Call Letter, Final Rules and CMS Manuals. Recommends training objectives based on these ever-evolving documents.
Supervisory Responsibilities
This position has no supervisory responsibilities.
Client Responsibilities
This is primarily an internal client facing position with some external client facing efforts that requires excellent instructional development application skills as well as presentation and interpersonal communication skills (active listening/verbal/written). One must be able to; manage challenging learning environments and respond promptly to trainee needs. Solicit participant feedback to improve content. Respond to requests for enhancements to current service delivery methods. Responsible for addressing and resolving problems while appraising performance in classroom settings.
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 in a related field (or equivalent combination of education and experience) along with 5+ years' related training experience that combines instructional design and delivering classroom training. Must have 3+ years' (inclusive experience) with end-to-end creation of instructor-led and e-learning materials. Master's degree in instructional design, education technology or similar field is preferred. Prefer experience within the healthcare industry. Required Must have 1+ year experience with Government Regulatory agency protocols, validating and researching documentation sources.
Certifications, Licenses, Registrations
Industry certifications in instructional design, curriculum development, performance improvement is strongly preferred.
Computer Skills - To perform this job successfully, an individual should have a strong working knowledge of Instructional design software and tools (Adobe Captivate, Articulate Presenter/Storyline, Photoshop, Illustrator and Flash), web and application development languages, experience using a LMS to host content; video production tools; Microsoft Office Suite including expertise with PowerPoint. Must have a demonstrated ability to learn new software.
Other Skills and Abilities
· Strong working knowledge and demonstrated skills using ADDIE for instructional and curriculum design, applying systematic development of learning experiences.
· Must have curriculum design skills in technical and operational areas. Proficient at analyzing processes and making recommendations for improvements. Ability to effectively communicate information, policies, and/or procedures in a manner easily understood by the recipient.
· Talented at investigating and analyzing information to draw conclusions. Demonstrated aptitude to work well with diverse individuals.
· Demonstrated capacity to gather and analyze data and make recommendations to manage growth and change.
· Able to document work in progress.
· Strong analytical, verbal and written communication skills; good interpersonal, public speaking, instructional organizational and time management skills.
· Must be able to work effectively with diverse individuals.
· Demonstrated maturity of judgment under pressure and the ability to resolve/mediate problems. Apt to maintain a high degree of confidentiality, using tact, discretion and professionalism in all aspects of the job. Strong attention to detail and follow-through skills.
· Demonstrate high commitment to the subject and each training event. Show genuine concern for the participants.
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, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Language Skills
Ability to read, analyzes, and interprets 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.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
· Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
· Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.
· Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
· Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
· Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
· Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Develops realistic action plans. Good organizational and time management skills.
· Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
· Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
· Verbal Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Projects a situational ability to relate to specific situations and participants. Does not always provide the solutions to problems or questions and does not always suggest the way forward.
· Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
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 occasionally required to stand while presenting. The employee is occasionally required to 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is in an office setting and is exposed to moderate noise, (examples: business office with computers and printers, light traffic) 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 one to work the hours needed to get the job done. Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. This 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.
$71.6k-95.8k yearly Auto-Apply 60d+ ago
Accreditation, Quality & URL Specialist
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 60d+ ago
Pharmacy Resident - Managed Care
Medimpact 4.8
Medimpact job in San Diego, CA
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 13d ago
Principal, Process Architecture & Delivery
Medimpact 4.8
Medimpact job in San Diego, CA
Exemption Status:United States of America (Exempt)$132,323 - $186,576 - $240,828
“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 Principal, Business Process Architecture and Delivery will develop and implement initiatives to make our PBM and Software as a Service (SaaS) offerings market leading with an emphasis on claims and clinical processes and systems. You will lead project teams and partner with business and operations leaders, clinicians, technical partners and dedicated project leaders to identify and design operational improvements, efficiencies and best practices within prioritized work streams to improve PBM and SaaS offerings, facilitate PBM integration and to optimize operational and clinical practices. In this role you will lead initiatives to shape the future of the organization. While addressing immediate business needs, you will create and implement improvements to claims, clinical and operational practices supported by technology in line with strategic goals.
Essential Duties and Responsibilities include the following. Additional duties may be assigned.
Develop and maintain a deep understanding of the core business and clinical processes by working with business and operations leaders, clinicians, analysts and enterprise architects to build and maintain business capability models and value streams.
Be a strong influencer and change agent to implement improvements to technology and business and operating models to improve service, quality and efficiency of the products and services we offer.
Communicate both internally and externally the competitive advantages of our claims and clinical platforms and improvement roadmaps in the PBM and SaaS marketplaces.
Evaluate and quantify the health and maturity of business capabilities across the enterprise
Facilitate discussions with operations, clinical, technical and business leaders to identify current and future priorities that inform the improvement plan or roadmap
Collaborate with operations, clinical, technical and business leaders and project managers to develop improvement strategies tied to key business performance metrics and translate these strategies and technology objectives into an actionable roadmap
Leveraging Agile methodology, collaborate with the technology leaders to translate optimized operational, clinical and business practices into clear business requirements for technology implementation.
Participate in the Technology roadmap reviews to evaluate and approve technology deliverables that align with the strategic goals of the projects.
Organize plans and partner with business, technical, clinical and operational leaders to implement changes to business processes including launches of new technologies
Mentor others and help drive the maturity of the enterprise business process architecture practice
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; and ensure client commitments are met in a timely manner.
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 or Doctorate Degree in Pharmacy or Bachelor's Degree in Business, Operations, Engineering or Information Services or equivalent combination of education and experience. 10+ years of experience in PBM, managed healthcare, insurance or consulting to these organizations required along with 8 years of SME in respective areas. 4+ years supervisory experience. Experience with pharmacy benefit management software. SaaS experience highly desirable.
Computer Skills
Proficient with MS Suite (Word, Excel, Visio, Outlook, Project) and SmartSheets to create data strategy roadmaps, manage priorities and share vision for organization growth.
Experience with system modernization, data conversion and integration of operating platforms
Experience in creating business process flow and business requirements documentation that feed software architecture and system design documentation
Experience delivering SaaS products and services
Experience in healthcare industry is a plus.
Experience in data science, machine learning and AI is a plus.
Certificates, Licenses, Registrations
None required
Other Skills and Abilities
Sound knowledge of industry standard best practices and innovations in the realm of data platform
Extensive knowledge of strategy setting, program requirements, product development and project management methodologies
Demonstrated analytical and logical reasoning
Adept in problem solving and change management
Demonstrated ability to be client focused, responsive, flexible, and positive
Ability to work effectively with external partners/vendors to implement new solutions.
Proven ability to work as a team player and collaborate effectively with peers
Excellent time management skills and ensure deadlines are met.
Demonstrated ability to influence others in meeting enterprise goals.
Excellent organizational and communication skills (both written and verbal).
Experience working with agile methodology is a plus.
Reasoning Ability
Ability to apply industry best practices in local solution designs. 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 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 and respond to questions from groups of managers, clients, customers, and the public. Excellent listening, written, verbal and telephone communication skills are essential. Ability to relay technical information in a non-technical manner
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Analytical - Synthesizes complex or diverse information; Collects and researches data; Identifies data relationships and dependencies; uses intuition and experience to analyze data and relationships; designs workflows and procedures.
Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests.
Technical Skills - Demonstrates required skills; Adapts to new technologies; Troubleshoots technical problems; Uses technology to increase productivity; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others; Exhibits ability to learn and apply new skills; Keeps abreast of current developments; Displays understanding of how job relates to others.
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; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.
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 quiet.
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 one to work the hours needed to get the job done. Therefore, one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. This 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 as well as attendance 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.
$132.3k-186.6k yearly Auto-Apply 60d+ ago
Medical Director Clinical PBM Operations
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 41d ago
Data Scientist V
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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
Drug Data Classification & Maintenance Pharmacist
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 36d ago
Rebate Payment Analyst I
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 22d ago
Rebate Operations Analyst-1
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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
Summary
This position is responsible for all drug rebate activities, both financial and operational. This includes the processing of quarterly rebate invoices, preparing and delivering monthly and quarterly rebate reports and working through dispute resolution process with manufacturers.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Analyzes disputed data and works with drug manufacturers to fairly and accurately resolve disputes.
Assists clients with Pharmacy audits providing requested information and support.
Assisting with payment posting, collections, and maintaining all client service agreements.
Executes billing processing for over 800 manufacturers per program; performs quality assurance activities and corrects any errors prior and post invoice generation within timelines required under contract.
Invoicing practices, including pre-invoicing review for fee for service, managed care, diabetic supply and supplemental rebate programs.
Review drug rebate claims for errors that will impact invoicing.
Performs provider audits in order to verify product and quantity dispensed.
Sends out past due notices to drug manufacturers.
Main point of contact for State for all rebate programs.
Performs monthly and quarterly financial reconciliation with the State.
Fulfills client requests for reporting, invoicing and any other rebate related needs.
Attends meetings and conference calls as needed.
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
To perform this job successfully, an individual must be competent with Microsoft Word, Excel, and Outlook software. The individual is expected to develop competence with MedInvoice rebate system or other business intelligence software, as well as with proprietary systems/databases used by MedImpact.
Certificates, Licenses, Registrations
None required.
Other Skills and Abilities
Possess excellent communication skills (both verbal and written), analytical and/or financial reasoning skills.
Familiar with service contracts and contract interpretation.
Strong knowledge of pharmacy services with an emphasis on the managed health care environment.
Reasoning Ability
· Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
· 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 effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
.
· Ability to write reports, business correspondence, and procedure manuals.
Competencies To perform the job successfully, an individual should demonstrate the following competencies:
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).
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 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.
$71.6k-95.8k yearly Auto-Apply 60d+ ago
Director, Business Intelligence & Reporting Platform
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 13d ago
Bilingual Provider Relations Contract Analyst (on-site in Puerto Rico)
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 15d ago
Software Engineer III
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
Exemption Status:United States of America (Exempt)$95,717 - $132,808 - $169,898
“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.
Writes code and performs programming, testing, and debugging of software applications.
Maintains existing applications for maintenance of business
Analyzes methods to efficiently address software system requirements
Finalizes forms, procedures, and documentations needed for installation and maintenance of application programs.
Practices good software engineering techniques and standards to minimize coding errors and ensure robustness and efficiency of work products.
Partners with software teams in the development of software engineering processes. Participate in software project meetings and provide status reports.
Interfaces with internal IT staff including Quality Assurance, Software Architects and others. Works with Operations and business partners to add new or custom features to company products.
Assumes full end-to-end accountability and responsibility for assigned tasks as well as the end production delivery.
Applies software engineering and Object Oriented Design principles as well as utilizes UML based design documents and code to create or enhance software.
Supervisory Responsibilities
No supervisory responsibilities.
Client Responsibilities
This is an internal 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
Bachelor's degree (or equivalent combination of education and experience) along with a minimum of BS/BA and 6+ years' experience or equivalent combination of education and experience, and 2 years of SME in respective areas. Pharmacy Benefits Management or related industry a plus.
Computer Skills (and technologies)
To perform this job successfully, an individual should have knowledge and experience with:
Expert experience working knowledge of a Java, Spring, Spring boot, JPA, Hibernate.
Experience building UI with JavaScript, JavaScript libraries and JavaScript frameworks like Angular and/or React.
Experience in RESTful web services or APIs development.
Experience with relational database management systems (RDBMS such as Oracle or similar) a must.
Experience with Unix/Linux platform and sufficient commands a must.
Experience with Apache, Tomcat, Maven, JIRA, Confluence, Bitbucket
Familiarity with service-oriented architecture and microservices architecture.
Experience in API Gateway, Gravitee experience is a plus.
Experience with software deployment and release, Jenkins and CI/CD.
Knowledge of Kubernetes deployment architecture.
Proficiency with cloud platforms is a plus.
Experience in Agile scrum methodology and SDLC process.
Certificates, Licenses, Registrations
None required
Other Skills and Abilities
Familiar with software development lifecycle; working knowledge of software engineering including analysis, design, development, implementation, and verification; Thorough knowledge of software methodologies, distributed networking, databases, communications, and multiprocessing applications. Ability to apply technical standards, principles, theories and techniques. Must be able to work collaboratively on teams and shift priorities in a fast-paced environment.
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 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 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 before groups of customers or employees of organization.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Technical Skills - Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
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 walk; sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
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.
While performing the duties of this Job, the employee is occasionally exposed to risk of electrical shock. The noise level in the work environment is usually moderate.
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 one to work the hours needed to get the job done. Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. This 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 as well as attendance 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.
$95.7k-132.8k yearly Auto-Apply 59d ago
CISC Care Coordinator, Licensed
Magellan Health 4.8
Carlsbad, CA job
Independently coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties performed are either during face-to-face home visits or facility based depending on the assignment. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. May act as a team lead for non-licensed care coordinators.
Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.
Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately (e.g., during transition to home care, back up plans, community based services).
Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
Acts as an advocate for members' care needs by identifying and addressing gaps in care.
Performs ongoing monitoring of the plan of care to evaluate effectiveness.
Measures the effectiveness of interventions as identified in the members care plan.
Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.
Collects clinical path variance data that indicates potential areas for improvement of case and services provided.
Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.
Provides assistance to members with questions and concerns regarding care, providers or delivery system.
Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
Generates reports in accordance with care coordination goals.
Other Job Requirements
Responsibilities
Associate's Degree in Nursing required for RNs, or Master's Degree in Social Work or Healthcare-related field, with an independent license, for Social Workers.
Licensed in State that Services are performed and meets Magellan Credentialing criteria.
2+ years' post-licensure clinical experience.
Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.
Experience in analyzing trends based on decision support systems.
Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.
Knowledge of referral coordination to community and private/public resources.
Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.
Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.
Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.
Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.
Ability to establish strong working relationships with clinicians, hospital officials and service agency contacts. Computer literacy desired.
Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills.
General Job Information
Title
CISC Care Coordinator, Licensed
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associate - Nursing, Master's - Social Work
Education - Preferred
License and Certifications - Required
DL - Driver License, Valid In State - Other, LISW - Licensed Independent Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$58,440
Salary Maximum:
$93,500
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.
$58.4k-93.5k yearly Auto-Apply 60d+ ago
Project Manager
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 28d ago
Principal, Network Engineering
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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 52d ago
Business Digital Solutions Manager
Medimpact Healthcare Systems 4.8
Medimpact Healthcare Systems job in San Diego, CA
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
Learn more about MedImpact Healthcare Systems jobs