Drug Data Classification & Maintenance Pharmacist

MedImpact Healthcare Systems, Inc.•San Diego, CA

29d•Onsite

About The Position

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! The Drug Classification & Maintenance Pharmacist participates in the development and maintenance of Core Formulary Processes focusing on the Formulary Maintenance Weekly Drug Update activities including Proxy and CUI maintenance related to the Part D MedImpact Standard and Custom formularies and other functions as required

Requirements

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas
To perform this job successfully, an individual must have solid computer skills including Microsoft Office (Word/Excel), MS Outlook and familiarity with industry standard databases. Understand, create and execute basic SQL queries and relational databases
Valid Registered Pharmacist license in the State of California or equivalent state
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Nice To Haves

Prior experience with Medicare Part D and CMS formulary submission and maintenance processes highly desirable.
Operates with flexibility in a changing business and government regulated environment.
Must be able to establish a good working knowledge of MedImpact clients and operational departments and have ability to bridge departmental boundaries
Prior experience in PBM formulary setup and maintenance, relational and analytical database management programs, as well as, familiarity with First Databank, Medi-Span and RxNorm drug files preferred.
Assists in the development and promotion of the business unit’s vision, goals, and objectives in support of the Company’s overall objectives; Develop and further extend MedImpact’s efficiency and accuracy of Formulary Enterprise applications, Part D drug lists, and government programs.
Participates and supports audit processes as a clinical subject matter expert; provides necessary information, documentation and analysis required by audits; support departmental and corporate development of audit support infrastructure
Provides direct consultation on drug mapping and classification maintenance operations, programs, and software for multiple line(s) of business managed within MedImpact’s formulary management software.
Support colleagues in a range of accountabilities by being versed in cross-functional operations within the department

Responsibilities

Principal SME Pharmacist on CMS Part D drug eligibility and placement. Maintains and oversees appropriate Part D assignment and CUI mappings of drugs consistent within utilization management groupings of drugs. Reviews new drug categorization changes to customize, implement, and integrate with MedImpact formulary products as appropriate. Monitors drug vendor and regulatory bodies for operational or strategic market changes. Collaborates with the MedImpact National Drug Data File (NDDF) Team as well as MedImpact Drug Information Services to ensure success.
Performs complex data analytics based upon external drug data provided to MedImpact by FDB, MediSpan, RXNorm and CMS FRF.
Acts as a clinical and analytical subject matter expert on areas pertaining to Part D drug mapping and classification and supports development and implementation of mapping and PPDL programs.
Responsible for interpretation and implementation of CMS guidance related to each of the Part D PPDL drug lists. Maintains Formulary Services’ CMS Part D Pre-Processing Drug Lists (PPDL) which include weekly review and yearly update CMS_PPDL Drug Lists: The accurate maintenance of lists is essential to CMS Part D compliance and accurate claim adjudication.
Processes the monthly / yearly CMS FRF and NIH’s RxNorm drug update files to ensure accurate and compliant file submission to CMS.
Serves as Drug Data Management’s designated contact for communication to NIH’s RxNorm for general inquiries and data correction requests.
Masters a variety of analytical and quality control tools to ensure formulary drug data accuracy and integrity. Simultaneously engages in the activities and timelines for multiple CMS Plan years with differing and sometimes conflicting rules and regulations.
Contributes to and assists with current Drug Data Management and formulary enterprise priority projects, programs, or initiatives as defined by leadership. Coordinates inter- and intradepartmental project activities and groups as necessary to meet project goals and timeframes.
Provides internal consultation on CMS statutory regulations specific to Part D eligibility status and Part D related GPS programs PPDL drug lists.
Executes within the confines and timeframes provided by CMS which may include non-standard business hours.
Collaborate with MedImpact’s Health Services advisors, Formulary Administration Pharmacists, IT partners, NDDF (FDB / MediSpan), Drug Information, Configuration Services team to ensure accurate drug mapping and classifications contents abide by Part D guidance.
Ensures that the mapping and classification changes occur in an appropriate, accurate, and timely manner based on drug data and Part D guidance.