Clinical Operations Pharmacist

MedImpact Healthcare Systems, Inc.; United States; Hybrid; USD 109,000 - 196,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. is seeking a Clinical Operations Pharmacist to optimize clinical quality and cost-effectiveness for client plans. The role emphasizes analytic support, data-driven decision making, and collaboration across teams to improve outcomes and manage drug utilization.

Requires a PharmD with 3+ years of experience and a California license. The position involves on-site and remote work within EST alignment, with opportunities to influence formulary and rebate strategies.

Qualifications

• PharmD and 3+ years’ experience, or equivalent mix of education and experience, and 1 year SME in respective areas.
• Valid Registered Pharmacist license in CA or equivalent state.
• Experience with Medicaid formulary management, including development/maintenance of state PD lists (PDLs).
• Proficient in MS Office, Access, Excel; familiarity with relational databases; knowledge of SQL or Python is preferred.

Responsibilities

• Lead and support analytic initiatives to optimize drug utilization and cost.
• Provide clinical subject matter expertise and align clinical and business goals.
• Support drug formulary analysis, P&T processes, and online system edits.
• Coordinate clinical utilization analyses and present findings to clients.
• Contribute to DUE, DUR, and QI programs to meet NCQA guidelines.
• Assist with client-facing clinical and financial performance strategies.

Skills

Analytical skills

Health informatics experience

Education

PharmD and 3+ years’ experience

Tools

Microsoft Office

Access

Excel

Relational databases

SQL

Python

Job description

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

This role requires the selected candidate to work within the Eastern Standard Time (EST) zone.

Summary

The Clinical Operations Pharmacist provides analytic/technical support to optimize the clinical quality and cost-effectiveness of drug and medical therapy, as applicable, for client plan sponsors and their members. Focuses on rational management of drug utilization by employing analytical tools and an evidence-based approach to achieve lower net cost, better health outcomes, and higher levels of satisfaction for plan sponsors, and their members. The role manages operational aspects of clinical operations, strategic initiatives, projects, and/or programs. This position focuses on supporting analytic, technical, and operational aspects of clinical management. The role collaborates across the organization. The role relies on data and performance indicators, as well as experience and judgment, to identify and promote performance improvement opportunities which attain the aligned goals of MedImpact and assigned clients.

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

• Manages, contributes and assists in current priority, projects, programs or initiatives as defined by supervisor. Provides clinical subject matter expertise and combines with business operations knowledge to ensure clinical and business appropriateness and success;
• Assists with related analytic needs to support recommendations being considered by assigned clients that align with both the clients’ and MedImpact’s mutual goals of lower net costs and high clinical quality. The strategic recommendations may include: benefit design and formulary analysis and suggestions, provision of clinical drug information, client P&T support and participation, recommendations for rational drug formulary positioning, on-line system edits and restrictions, on-going clinical product evaluations, and recommendations regarding client pharmacy benefit utilization and performance trends;
• Supports clinical consultative services in accordance with contracted clinical services. The role is an integral part of designing, developing, and driving the clinical components of their assigned account team’s strategic and financial goals. Ongoing focus will be centered on using a variety of analytical tools and clinical resources to identify opportunities which simultaneously improve the plan sponsor’s quality-focused and financial performance metrics;
• Supports analytics necessary for MedImpact’s evidence-based interventions and communication programs to clients. Provides documentation of recommendations for clinically appropriate and financially beneficial clinical initiatives (e.g. lower net cost, generic programs, QA programs, clinical and specialty programs, and applicable rebate management);
• Coordinates clinical utilization analyses, in collaboration with key stakeholders, to support presentations to clients. Ensures timely and accurate review of plan data, according to policy, with appropriate intervention recommendations;
• Supports, implements, and maintains DUE, DUR, and QI programs to meet plan, HEDIS, and NCQA guidelines;
• Coordinates clinical support of Drug Formulary and Preferred Drug Lists during plan sponsor’s implementation and maintenance of business in collaboration with the Clinical Account Executive (Client Team);
• Supports recommended clinically appropriate initiatives to optimize the value of MedImpact’s rebate administration program for clients while delivering on the lower net cost goal;
• Supports MedImpact P&T Committee quarterly meetings and weekly FirstDataBank (FDB) and/or MediSpan drug updates.

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 and proficient knowledge of Access, Excel and relational databases.

Certificates, Licenses, Registrations

Valid Registered Pharmacist in the State of California or equivalent state.

Other Skills and Abilities

• Analytical skills with Health Informatics experience.
• Must possess experience in Medicaid formulary management, including the development, maintenance, and oversight of state Preferred Drug Lists (PDLs)
• Other technical skills preferred (Access, SQL or Python)
• Part D, Commercial, MarketPlace Formulary experience preferred.
• Experience in promoting disease management and/or drug cost management programs preferred.
• Experience working with PBM or health plans.

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

• 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 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 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 acruity 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 may require domestic travel 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

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/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.