Job Details
Exemption Status:
United States of America (Exempt)
$110,714 - $155,000 - $199,286
"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
Job Description
Summary: The Pharmacist in Charge, PA & UM Programs manages accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. Additionally, this position focuses on supporting the education and training needed by clinical specialists and prior authorization coordinators, which will support cost-effective, rational drug, and disease therapy, utilizing distinct but inter-related management and cross-departmental functions.
Current, unrestricted Registered Pharmacist license in the State of Colorado
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- As a "hands on" working manger, the position is responsible for approximately 60% supervisory activities and 40% clinical specialist prior authorization (PA) administration tasks. This breakdown will fluctuate in accordance with business need, as some days will require more supervision and others will require for PA administration.
- Works with the PA Management department to oversee the compliance, timeliness, and effectiveness of delivering high quality outcomes for the PA and Utilization Management (UM) programs at MedImpact. Develops and administers policies, business processes and quality standards. In conjunction with the Prior Authorization (PA) Managers and supervisors within the department, this role ensures that PA decisions are on time and meet the quality levels expected by MedImpact's internal and external customers. Serves as backup for the department manager.
- Assists team members in process improvement including design of work flow processes and implementation of technology to support work processes; Helps to support work flow by assisting the team with strategic workflow management, scheduling, and adjusting the workflow in the event of a staffing challenge.
- Provides oversight and expertise to the PA team.
- Monitors and provides feedback to improve quality of services provided by Prior Authorization operations group including design, oversight, and review of quality and productivity reports; Helps in conveying areas for improvement to clinical and administrative staff; Assists audit team in investigations of PAs, in conveying audit feedback to clinical team and developing PA process enhancements.
- Participates in the design and implementation of PA and other Utilization Management programs for new and existing clients, including design and development of standard and customized PA. Helps to maintain on-going client interaction for key clients regarding PA program assessment and improvement.
- Partners to develop policies and procedures to document and maintain compliance with NCQA standards and state and federal legislation and regulations as applicable.
- Assists with regularly scheduled individual and departmental meetings that will cover training and operational issues for the Clinical Review and Quality. Oversees the continuing development of staff and recommend appropriate training modules. Works to operationalize scheduling and monitoring of new clinical staff onboarding.
- Provides clinical support services to client plan(s) contracting for clinical services. Support services will include, but not limited to, clinical review, analysis, recommendation, decision, and documentation of prior authorization requests as required by client contracts and Utilization Management delegation agreements.
- Reviews medication request guidelines for clinical appropriateness and operational efficiency. Assists in the revision and creation of new or existing medication request guidelines as indicated.
- Provides drug information support. Researches and provides clinical literature documentation to support prior authorization decisions as indicated. Prepares Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review.
- Provides feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review. Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.
- Demonstrates and describes detailed processes of both operational and clinical processes.
- Provides recommendations to clients to promote MedImpact standardized processes and negotiates with high maintenance clients requesting customization of processes.
- Participates in PA business development activities including presentations to clients and prospective clients. Coordinates clinical support of PAUM activity during plan sponsor's implementation.
- Collaborates with PA, Customer Service, Benefits and Pharmacy Network operational management staff as well as Clinical Consultative Services (CPM Team and Drug Information/P&T support staff regarding application of PA program performance standards. Participates in cross-functional meetings as needed.
- Maintains on-going client interaction for key clients regarding PA program assessment and improvement.
- Participates in client facing meetings related to PAUM inquiries and defend MedImpact's PAUM dept policies/procedures.
Supervisory Responsibilities Assists with the supervision of clinical pharmacists and supervises others in the PA review process in the Prior Authorization and Utilization Management department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Client ResponsibilitiesThis 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; Assist with difficult or emotional client situations.
QualificationsTo 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 Doctor of Pharmacy (or equivalent combination of education and experience such as a bachelor's degree with a RPh designation) along with 5 years related experience. Prior management, supervisory or lead experience is strongly preferred.
Computer Skills To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and Outlook, strong familiarity with relational databases, ease of learning new software programs.
Certificates, Licenses, Registrations Current, unrestricted Registered Pharmacist license in the State of Colorado.
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 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 SkillsAbility 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:
- 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.
- 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.
- 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.
- 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.
- Cost Consciousness - Works within approved budget; Develops and implements cost saving measures; Contributes to profits and revenue; Conserves organizational resources.
- Strategic Thinking - Develops moderate strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Identifies external threats and opportunities; Adapts strategy to changing conditions
Physical DemandsThe 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; 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 EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
Work Location This position works on-site at the San Diego Headquarters or other company location (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 position. 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. The individual must be available to work assigned rotating weekends including on call shifts.
Travel - This position may require occasional domestic travel and attendance at local/national conferences or seminars.
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 www.medimpact.com/careers
MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
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.