Rebate Clinical Program Manager
About The Position
The Rebate Clinical Program Manager (CPM) optimizes the clinical quality and cost-effectiveness of drug rebate programs. The role focuses on operational management of medical drug utilization using analytical tools and works within an account team structure to achieve account and company financial goals. Using data, performance indicators, experience, and judgment, the CPM identifies and promotes performance-improvement opportunities aligned with MedImpact and assigned-client goals. The position provides clinical consultation and strategic recommendations to clients, including HCPCS/NDC analysis, online rebate system edits and restrictions, and accurate medical billing recommendations. It supports CMS dispute resolution processes, rebate data integrity, provider audits and education, claims analysis, clinically appropriate NDC-to-CMS rebate-unit conversions, client-specific reporting and financial analyses, and 340B strategic initiatives. This is an exempt position based on-site at the San Diego headquarters or another company location, with remote work possible with management approval based on business requirements. Domestic travel may be up to 10%. The role requires working the hours necessary to fulfill responsibilities and meet deadlines, including flexibility to work beyond traditional hours and nights, weekends, or holidays as required. Typical core business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.
Requirements
- PharmD and at least 3 years of experience, or an equivalent combination of education and experience.
- At least 1 year of subject-matter expertise in the respective areas.
- Registered Pharmacist license/registration.
- Knowledge of Microsoft Office Suite and working knowledge of relational databases.
- Ability to solve practical problems in situations with limited standardization and apply common-sense understanding to instructions and problems involving concrete variables.
- Ability to apply fractions, percentages, ratios, and proportions to practical situations, and work with probability, statistical inference, geometry, and trigonometry concepts.
- Ability to read, analyze, and interpret business and professional publications, technical procedures, and governmental regulations; write routine reports and correspondence; and speak effectively before groups.
- Ability to work the hours required to fulfill responsibilities and meet deadlines, including nights, weekends, or holidays when required.
- Ability to travel domestically up to 10% of the time.
- Ability to meet the described physical demands, including occasional lifting or moving of up to 25 pounds and close-vision tasks.
- Ability to provide adequate support to internal clients and participate in regular coordination and collaboration with employees, colleagues, clients, vendors, and stakeholders.
Nice To Haves
- Analytical skills with Health Informatics experience.
- Experience promoting drug cost management programs.
Responsibilities
- Provide recommendations to assigned clients aligned with mutual client and MedImpact goals, including HCPCS/NDC analysis, online rebate system edits and restrictions, and accurate medical billing recommendations.
- Provide clinical consultative services in accordance with CMS dispute resolution processes, using analytical tools and clinical resources to identify opportunities to improve rebate-program data integrity.
- Perform provider audits and provide provider education regarding medical claim billing for rebate processing.
- Analyze claims to identify incorrect or aberrant quantities billed for rebate invoicing.
- Develop, maintain, and recommend clinically appropriate unit-of-measure conversions for NDC billing to CMS rebate units.
- Respond to client-specific requests by producing reports and providing financial and drug-utilization data to assist states with financial solvency, drug-purchasing policies, and allocation of rebate monies.
- Ensure timely and accurate review of claim data according to policy, with appropriate intervention recommendations.
- Support 340B strategic initiatives.
Benefits
- Medical, dental, and vision coverage
- Wellness programs
- Paid time off
- Company-paid holidays
- Incentive compensation
- 401(k) with company match
- Life and disability insurance
- Tuition reimbursement
- Employee referral bonus
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
