Exemption Status:

United States of America (Exempt)

$188,204 - $272,896 - $357,587

“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

Summary

The Medical Director provides enterprise-level clinical leadership across all pharmacy benefit management (PBM) operations at MedImpact. This role is responsible for ensuring clinical integrity, regulatory compliance, and operational excellence in formulary management, P&T governance, utilization management, drug information, appeals & grievances, quality, and accreditation.

As a strategic physician leader, the Medical Director bridges clinical evidence, regulatory standards, and business strategy—ensuring that MedImpact delivers high-value, member-centered, and client-aligned pharmacy solutions that differentiates MedImpact.

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

Strategic & Clinical Leadership

• Serve as the clinical leader and subject matter expert across the PBM enterprise, advising executive and operational leadership.
• Lead the development of MedImpact’s clinical governance framework for formulary, P&T, and utilization management.
• Partner with the Chief Medical Officer and Vice President, Clinical Operations, and cross-functional teams to align clinical strategy with client outcomes, cost of care, and quality metrics.
• Lead and mentor a team of clinical professionals, promoting a culture of integrity, innovation, and accountability.
• Represent MedImpact in client meetings, industry panels, and clinical advisory boards, strengthening the company’s thought leadership in value-based PBM solutions.

Formulary Management & P&T Governance

• Chair or serve as executive medical liaison for the Pharmacy & Therapeutics (P&T) Committee, ensuring evidence-based formulary decisions.
• Oversee drug monographs, class reviews, and pipeline drug assessments to inform coverage strategy.
• Direct the creation and review of prior authorization, step therapy, and quantity limit criteria, balancing access, safety, and cost containment.
• Provide clinical guidance on pipeline therapies, biosimilars, GLP-1s, specialty drugs, and gene therapies, aligning with enterprise strategy.

Clinical Operations & Drug Information

• Oversee drug information and clinical policy functions, ensuring accuracy, timeliness, and defensibility of all clinical communications.
• Provide executive oversight of clinical programs such as medication therapy management, adherence interventions, and real-world outcomes measurement.
• Collaborate with Data & Analytics to evaluate the clinical ROI and health outcomes of formulary and utilization management programs.

Appeals, Grievances & Medical Review

• Lead oversight for coverage determinations, exceptions, and appeals, ensuring adherence to CMS, state, and accreditation standards.
• Implement peer review, inter-rater reliability, and quality audit protocols across all adjudication functions.
• Support clinical staff with escalated or complex medical reviews and ensure consistency in decisions across the organization.

Quality, Accreditation & Compliance

• Drive URAC, NCQA, and CMS accreditation readiness for all clinical departments.
• Lead clinical quality assurance programs, audit preparedness, and ongoing compliance monit