Rebate Clinical Program Manager (PharmD)

medimpact; United States; On-site; USD 109,000 - 196,000; Full time

Job summary

MedImpact Healthcare Systems, Inc. is seeking a Rebate Clinical Program Manager to optimize clinical quality and cost-effectiveness of drug rebates.

The role focuses on operational management of medical drug utilization, using data-driven performance indicators to identify improvement opportunities within client accounts. The position requires a PharmD with 3+ years of experience and SME in related areas; expertise in CMS dispute processes and health informatics is preferred.

Qualifications

• PharmD and 3+ years' experience, plus SME in respective areas.
• Experience with Health Informatics and analytics in rebates.
• Proficiency with Microsoft Office Suite and relational databases.

Responsibilities

• Provide recommendations aligning client and MedImpact goals.
• Perform provider audits and education for medical claim billing in rebates.
• Develop and maintains CMS rebate unit conversions and reports.

Skills

Analytical skills

Health Informatics

Relational databases

Education

PharmD

1 year SME experience

Tools

Microsoft Office

CMS/rebate systems

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 include the following. Other duties may be assigned.

• 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. The CM's focus will be centered 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.

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 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 problem