Rebate Clinical Program Manager

Rebate Clinical Program Manager (CPM)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 MedImpact 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 MedImpact'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 ResponsibilitiesNo supervisory responsibilitiesEducation and/or ExperiencePharmD and 3+ years' experience or equivalent combination of education and experience, and 1 year of SME in respective areas.Computer SkillsTo perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases.Certificates, Licenses, RegistrationsRegistered PharmacistOther Skills and AbilitiesAnalytical skills with Health Informatics experience (preferred).Experience in promoting drug cost management programs (preferred).Reasoning AbilityAbility 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 SkillsAbility 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 SkillsAbility 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 To perform the job successfully, an individual should demonstrate the following competencies:ComposureDecision QualityOrganizational AgilityProblem SolvingCustomer FocusDrive for ResultsPeer RelationsTime ManagementDealing with AmbiguityLearning on the FlyPolitical SavvyPhysical 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 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 EnvironmentThe 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 LocationThis 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 HoursThis 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.TravelThis position requires domestic travel of up to 10% of the time.The Perks:Medical / Dental / Vision / Wellness ProgramsPaid Time Off / Company Paid HolidaysIncentive Compensation401K with Company matchLife and Disability InsuranceTuition ReimbursementEmployee Referral BonusEqual 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.