Rebate Clinical Program Manager

MedImpact•San Diego, CA

1d•Onsite

About The Position

The Rebate Clinical Program Manager optimizes the clinical quality and cost-effectiveness of drug rebate programs by managing medical drug utilization and applying analytical tools. Working within an account team, the role uses data, performance indicators, experience, and judgment to identify and promote improvements that support MedImpact’s and assigned clients’ goals. The position provides clinical and analytical recommendations, supports rebate processing and related initiatives, and helps clients use financial and drug utilization information to guide decisions. This exempt role is based on-site at the San Diego Headquarters or another company location. Remote work may be approved by management based on business requirements. The position requires regular collaboration with internal clients, colleagues, clients, and vendors, and domestic travel of up to 10%. Typical core business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; however, the employee must work the hours needed to meet responsibilities and deadlines and be flexible to work beyond traditional hours, including nights, weekends, or holidays when required.

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.
Knowledge of Microsoft Office Suite and working knowledge of relational databases.
Ability to solve practical problems and handle situations with limited standardization.
Ability to apply mathematical concepts such as fractions, percentages, ratios, proportions, probability, and statistical inference to practical situations.
Ability to read and interpret business and professional publications, technical procedures, and governmental regulations; write routine reports and correspondence; and speak effectively before groups.
Ability to meet the described physical demands, including occasionally lifting and/or moving up to 25 pounds and maintaining close vision for reading fine print and viewing computer screens.
Flexibility to work beyond traditional hours, including nights, weekends, or holidays as required.
Ability to travel domestically up to 10% of the time.

Nice To Haves

Health informatics experience and analytical skills.
Experience promoting drug cost management programs.

Responsibilities

Provide recommendations to assigned clients that align with clients’ and MedImpact’s mutual goals, including HCPCS/NDC analysis and suggestions, online rebate system edits and restrictions, and recommendations for accurate medical billing.
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, produce reports, and provide financial and drug utilization data to help states determine financial solvency, drug purchasing policies, and allocation of rebate monies.
Review claim data in a timely and accurate manner according to policy and recommend appropriate interventions.
Support 340B strategic initiatives.