Principal Pharmacist MedGenerations

MedImpact Healthcare Systems, Inc.•San Diego, CA

7d•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! MedImpact delivers 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 Principal Pharmacist for MedGenerations provides clinical leadership and oversight to MedImpact’s PDP program. This position requires knowledge of the Part D standard benefit and its linkage to Formulary, Part B versus D benefits, Benefits Design, Finance, Premium Development, and Part D bid components.

Requirements

PharmD Degree
8+ years related experience and 8+ years of SME in respective area(s)
at least 4+ years leading individual contributors and leaders of leaders
strong knowledge of Microsoft Office Suite
working knowledge of relational databases
Registered Pharmacist in the State of California or equivalent state preferred
CMS audit experience preferred
In-depth knowledge of the health care industry required
In-depth knowledge of the PBM industry and Medicare program strongly preferred
Strong understanding of MedImpact a plus
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
Ability to define problems, collect data, establish facts, and draw valid conclusions
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume
Ability to apply concepts of basic algebra and geometry
Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization

Nice To Haves

equivalent combination of education and experience
which may be substituted with an appropriate mix of leadership experience and 5 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (VP+ level) that must completed within 12 months in new position

Responsibilities

Provide clinical leadership and oversight of MedImpact’s Medicare Part D Prescription Drug Plan
Clinical Management - Leads the development and use of clinical strategies and analytics to impact pharmacy trend and improve plan’s Star Ratings including recommendations for formulary development and other clinical programs
Utilize pharmacy claims data to identify patterns of utilization and opportunities for financial and clinical plan improvement
Monitor and investigate pharmacy claims data to identify patterns of utilization and opportunities for financial and clinical plan improvement
Manage Star Ratings Acumen Patient Safety reports including monthly evaluation, ongoing tracking and trending, and other resources
Manage all aspects of the clinically related Denied Claim review and Opioid Overutilization Case Management programs including any related updates to proprietary documentation tracking software programs, protocol and P&P development, CMS program compliance and documentation submissions, and staff development and oversight
Participates on the MedImpact P&T Committee
Manage Medication Therapy Management Program (MTMP) criteria, data analysis and trending, MTMP CMS submissions, and perform MTMP vendor oversight
Provide support and clinical guidance for plan Compliance Officer, General Manager and Medical Director
Clinical spokesperson for the plan during CMS and/or third-party formulary administration audits
Directs the development and maintenance of clinical messaging for employers and providers; supports material development for members
Plan Sponsor Clinical/Compliance Support - Provides clinical expertise to our CMS plan sponsor, MG Insurance, as required; member of the Compliance Committee
Monitor and investigate pharmacy claims data for suspected FWA and implement strategies for correction
Oversees and conducts clinical related monitoring and management of trends originating from appeals and clinical grievances
Provides clinical support to brokers/ agents as required in the sales and renewal process
Financial Risk Administration - Participates with the underwriting/PDP team in the successful financial development of high-quality affordable pharmacy benefits for the EGWP, market
Clinical Trend Management Reporting - Develops reporting packages; monitors reports for PDP costs and performance trends; reports to senior management; implements programs to manage to trend/premium targets
Any related duties as required to ensure successful PDP products and financial results
Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit
Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems
Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary
This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written)
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