Rebate Clinical Program Manager (PharmD)

MedImpact Healthcare Systems Inc.; San Diego (CA); On-site; USD 109,000 - 152,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness 1

Paid Time Off / Company Paid Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. in San Diego, CA, seeks a Rebate Clinical Program Manager to optimize clinical quality and cost-effectiveness of drug rebates. You will work within an account team to drive performance improvements, using data and indicators to meet client and company goals.

The role emphasizes analytical work, CMS processes, and 340B initiatives, with responsibilities including reporting and client-facing support. This is an exempt position based in San Diego.

Qualifications

• PharmD and 3+ years’ experience or equivalent combination of education and experience.
• Knowledge of Microsoft Office Suite and relational databases.
• Registered Pharmacist.
• Analytical skills with Health Informatics experience (preferred).
• Experience in promoting drug cost management programs (preferred).

Responsibilities

• Provide recommendations that align with client and MedImpact goals, including HCPCS/NDC analysis and billing guidance.
• Offer clinical consultative services in CMS dispute resolution processes.
• Use analytical tools to identify opportunities to improve data integrity of the rebate program.
• Perform provider audits and education for medical claim billing related to rebates.
• Conduct claims analysis for incorrect or abnormal rebate invoicing quantities.

Skills

Health Informatics

Analytical skills

Relational databases

Microsoft Office Suite

Education

PharmD

Tools

CMS dispute resolution

HCPCS/NDC analysis

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 Summary

The Rebate Clinical Program Manager (CPM) optimizes the clinical quality and cost‑effectiveness of drug rebate. Focuses on operational management of medical drug utilization by employing analytical tools. Works within an account team structure to achieve overall account and company financial goals. 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 Medlmpact and assigned clients.

Essential Duties and Responsibilities

• Provides recommendations to assigned clients that align with both the clients’ and Medlmpact’s mutual goals. The strategic recommendations include: HCPCS/NDC analysis and suggestions, on‑line rebate system edits and restrictions, and recommendations for accurate medical billing.
• Provides clinical consultative services in accordance with CMS dispute resolution processes.
• Focuses on using a variety of analytical tools and clinical resources to identify opportunities which simultaneously improve the data integrity of the rebate program.
• Performs provider audits and provider education for medical claim billing in regards to rebate processing.
• Conducts claims analysis for incorrect, aberrant quantities billed for rebate invoicing.
• Develops, maintains and recommends clinically appropriate unit of measure conversion for all NDC billing to CMS rebate units.
• Other activities are centered on client specific requests and involve production of reports and providing financial and drug utilization data that assist the state(s) in determining their financial solvency, drug purchasing policies and allocation of received rebate monies.
• Ensures timely and accurate review of claim data, according to policy, with appropriate intervention recommendations.
• Supports 340B strategic initiatives.

Client Responsibilities

• 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: knowledge of Microsoft Office Suite and a working knowledge of relational databases.
• Certificates, Licenses, Registrations: Registered Pharmacist.
• Other Skills and Abilities: Analytical skills with Health Informatics experience (preferred). Experience in promoting drug cost management programs (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 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 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, 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

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. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

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 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

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.

MedImpact was founded more than three decades ago by a pharmacist and independent drug store owner who saw firsthand how families struggled with the high cost of prescriptions, and how it impacted their lives, financial security, and health. So, he started MedImpact to make prescription benefits understandable and accessible. While we have grown to be one of the leading PBMs in America, we remain as committed to these principles today as we did when it all began.