Quality Control Operations Manager

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

Position Summary: 

The Quality Control Operations Manager is responsible for managing operations that are necessary to ensure the proper administration of the Medicare Part D, Medicaid and Exchange lines of business. Frequent independent judgments are essential.

Essential Functions and Responsibilities include the following. Other duties may be assigned.

• Manages the process of evaluating the results of existing quality control processes related to Part D claim adjudication, eligibility and PDEs.

• Maintain models with an eye towards continuous improvement and expansion of capabilities, making recommended changes to Sr Leadership

• Manages the annual testing associated with the launch of new plan years.

• Execute monthly monitoring and evaluation of all Part D claim adjudications and share findings with appropriate parties for remediation purposes

• Stay abreast of all Medicare Part D regulatory changes related to PDEs, claim adjudication, eligibility, etc. Update models accordingly for testing of system processes.

• Oversees the annual maintenance and update of existing EGWP pricing model

• Maintain SAS data necessary for all processes (CMS communication files, Public Use Files, Landscapes, Oracle data, SQL server data, etc.)

• Identify areas of needed improvement from both a service and financial perspective, share findings with Sr Leadership and assist others with remediation.

• Track findings over time. Develop reporting and metrics to demonstrate the expected continuous improvement of operations and to show areas of strengths and weaknesses.
• Recommends and implements improvements to existing data analytics processes and assist with adoption of new software tools;

• Effectively communicates (written and oral) technical and statistical findings;

• Meets predetermined project deadlines and manages work on multiple projects.

Education and/or Experience                                            

Degree from a four-year college or university with strong quantitative skills; 8+ years of related experience in areas of statistics or health data analysis or equivalent experience in statistics with pharmaceutical or public health background required; or an equivalent combination of education and experience.

Computer Skills

Extensive experience using Microsoft Office applications, especially Excel, SAS (intermediate to advanced level), writing SQL, or PL/SQL (intermediate to advanced level) queries involving multiple table joins and nested queries. Data visualization and business intelligence with Tableau, Power BI is a plus.

Other Skills and Abilities                                                    

Knowledge of relational database structures and schemas,. Knowledge of computer systems and information technology networks. Knowledge of statistical analysis, design and interpretation. Previous experience working with pharmacy claims data or similar data sets is desired.

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.