Medical Director - GPS

Exemption Status:

“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!

Job Description

The Government Program and Services (GPS) Medical Director develops and executes the clinical strategy and accountabilities for Government Programs and Services and supports various components of MedImpact’s Fee-For-Service and Managed Medicaid programs.

Essential Duties and Responsibilities include but are not limited to:

• Development, sustenance and demonstration of a GPS medical affairs function that provides expected services of the highest quality with respect to clinical knowledge, competence, judgment, operational effectiveness that reflects positively on the company and its mission to develop and provide pharmacy benefit management products, services and programs that deliver improved healthcare value and outcomes to clients.

• Support and participate in utilization management coverage determinations (CDAG) and CDAG processes and operations oversight, including prior authorization, utilization management, and appeals programs and liaison with operational business units to ensure quality and compliance in prior authorization and utilization management program execution

• Support and contribute to the FFS Medicaid supplemental rebate process including potential participation in value-base outcomes rebate negotiations/discussions, market share rebates negotiations/discussions and other (e.g., DME) rebate discussions. This role will require support from both a process and clinical perspective.

• Provide delivery and governance of operational performance metrics and reporting of the coverage determination decisions quality, efficiency, and effectiveness across first level prior authorization through appeals and redeterminations. Develop and maintain policies and procedures that ensure compliant and effective CDAG operations.

• Attendance, and active participation in, various state Pharmacy and Therapeutics (P&T) Committee meetings and the P&T process in the effort to identify and validate clinical value in drugs and therapeutics and appropriate formulary placement and applicable utilization management.

• Serve as a supplementary medical knowledge resource when needed by providing clinically cogent and evidence based interpretation, recommendations and critiques on clinical matters of interest to GPS leadership that assist in the direction and development of clinical product and services.

• Maintain all licenses professional licenses, certifications, and credentials required to demonstrate clinical competency.

• Provides  oversight and management of contracted medical service providers and other services including clinical quality, credentials, and integrity, related to FFS Medicaid

• Provides support to the VP, Government Programs and Services in analytics and outcome research by developing clinically cogent analytic strategies, clinically important and meaningful queries, study concepts, study design, data management strategies, data interpretations for purpose of drawing meaningful inferences from data analyses and aggregations, such which would be of value to the company in developing and demonstration of value of MedImpact pharmacy benefit products to clients, vendors, presented at national meetings, and potential submission to relevant literature publications.

• Develop and demonstrate the business and organizational knowledge and skills to provide support to various internal and external stakeholders  including clients, GPS departments, , Account Management, Client support teams and Analytics.

Education and/or Experience                                             

Medical Degree M.D. or D.O. from an accredited medical education program and completion of an internship and residency program from an accredited program. Master’s degree in Business Administration, Masters in Public Health, or and post graduate training in business management is a plus.

Active Board Certification, preferably in Internal Medicine and a Subspecialty of the American Board of Internal Medicine required or equivalent certification in Family Medicine, or other specialty will be considered.

Four or more years of direct patient care in a medical practice setting exclusive of medical residency or fellowship required.

Medical management experience in or directly with a Pharmacy Benefit Management organization or Drug Utilization Management organization is preferred but not required.   

8 years of supervisory experience leading individual contributors and leaders of leaders;which may be substituted with an appropriate mix of leadership experience and 10 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

Licensure and Certification

Unrestricted active and unencumbered license to practice medicine in at least one state in which MedImpact supports clients, and the ability to obtain licenses in other states if necessary.  The AMD must maintain state licensure in those states where MedImpact has a need for licensure and where the AMD can obtain licensure.

Computer Skills

Thorough knowledge of Microsoft Office Suite, with emphasis on Word, Excel, Access, PowerPoint, Outlook, and Visio.  To perform this job successfully, an individual must also quickly gain a thorough understanding of MedImpact proprietary software tools related to formulary administration, pharmacy claims adjudication, and drug data management. 

Other Skills and Abilities                                                    

• Superior working knowledge of managed care practice settings with an emphasis on pharmacy benefit integration with medical care. 
• Expertise in medical review and medical management practices with ability to provide medical based peer review. 
• Excellent written and verbal communication skills with ability to work independently with other health care professionals. 
• Effectively respond to the most sensitive and complex inquiries and issues in real-time.

The Perks:

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

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.