Manager, PA & UM Programs

Manager, PA & UM Operations

$110,714 - $155,000 - $199,286

"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

This position is not eligible for Sponsorship.

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 Scoop:

The Manager, PA UM Programs develops and promotes the overall vision, goals, objectives and strategies for the Prior Authorization and Appeals Group in line with overall Health Services department goals and objectives.

What You Get To Do:

• Oversees the compliance, timeliness, and effectiveness of delivering high quality outcomes for the PA and Utilization Management programs at MedImpact
• Develops and administers policies, business processes and quality standards
• In conjunction with the Manager, PA Processing, ensures that PA decisions are on time, and meet the quality levels expected by MedImpact's internal and external customers
• Serves as backup for department Director
• Recruits, manages, and retains the necessary resources to successfully perform the duties of Prior Authorization Clinical Review and Quality Assessment
• Develops and manages a department budget for PA Clinical Review and Quality Assessment and Appeals group
• Leads team members in process improvement including design of work flow processes and implementation of technology to support these processes
• Provides oversight and expertise to the Clinical Review team and conducts appeals program clinical reviews
• Reviews operations to ensure that quality and timeliness of PA, Appeals is meeting established guidelines
• Monitors and provides feedback to improve quality of services provided by Prior Authorization operations group including design, oversight, and review of quality and productivity reports
• Develops and implements policies and procedures to document and maintain compliance with NCQA standards and state and federal legislation and regulations as applicable
• Assists with administration of the Utilization Management Oversight (UMOC) and Quality Steering Committee
• Conducts regularly scheduled departmental staff meetings that will cover training and operational issues for the Clinical Review, Quality and Appeals Group
• Oversees the continuing development of staff and recommends appropriate training modules
• Participates and collaborates on MedImpact's PA guideline and Utilization Management Program development and implementation process from a clinical and operational perspective
• Collaborates with PA, Customer Service, Benefits and Pharmacy Network operational management staff as well as Clinical Consultative Services (CPM Team and Drug Information/P&T support staff regarding application of PA program performance standards
• Participates in cross-functional meetings as necessary
• Participates in PA/Appeals business development activities including presentations to clients and prospective clients, consultative PA program development services and Executive Pharmacy briefings
• Participates in PA/Appeals product management activities including PA and appeals pricing and billing
• Participates in quarterly MedImpact P&T Committee meetings as requested by the Medical Director, and review or occasionally prepare Drug Monographs, as required
• Designs and implements PA and other Utilization Management programs for new and existing clients, including design and development of standard and customized PA
• Maintains on-going client interaction for key clients regarding PA program assessment and improvement

Supervisory Responsibilities

• Directly supervises clinical pharmacist employees and others involved in the PA review process in the Prior Authorization and Utilization Management department
• Carries out supervisor 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

Education and/or Experience

For consideration candidates will need:

• Bachelor's degree from a four year college or university or equivalent combination of education and experience required
• Pharm D preferred
• A minimum of five (5) to seven (7) years related experience in a PBM or healthcare environment
• Leadership experience may be substituted with four (4) years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (Dir ) for current active employees

Computer Skills

To perform this job successfully, an individual should have knowledge of Microsoft Office Suite Word Processing software.

Certificates, Licenses, Registrations

Valid registered Pharmacist license in the state of California or equivalent state.

Other Skills and Abilities

• Demonstrated ability to positively interact with clients, customers and assigned staff
• Demonstrated accountability for achieving service commitments and ability to achieve results in a production environment
• Excellent skills in written and oral communication; organization/prioritization; decision-making; problem analysis and resolution; negotiation; team building; and leadership
• Ability to maintain a high degree of confidentiality using, tact, discretion, and professionalism in all aspects of the job
• Strong attention to detail and follow-through skills. Ability to gather business requirements and client/vendor specifications

Travel

This position may require domestic travel.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

This position is eligible for Employee Referral Bonus at Level II

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/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.