Note: The job is a remote job and is open to candidates in USA. MedImpact delivers pharmaceutical and technology-related solutions that improve healthcare value, outcomes, cost, and quality. The Rebate Clinical Program Manager optimizes the clinical quality and cost-effectiveness of drug rebates through medical drug utilization management, claims analysis, clinical consultation, and client-facing recommendations. The role also supports provider audits, rebate data integrity, financial reporting, and 340B strategic initiatives.
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. 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
Skills
- PharmD and 3+ years' experience or equivalent combination of education and experience, and 1 year of SME in respective areas
- Registered Pharmacist
- To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases
- 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
- 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
- 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
- This position is not eligible for Sponsorship
- This position requires domestic travel of up to 10% of the time
- 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
- 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
- Analytical skills with Health Informatics experience (preferred)
- Experience in promoting drug cost management programs (preferred)
Benefits
- 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
- Remote work from a remote location with management approval based on business requirements
Company Overview