Exemption Status:

United States of America (Non-Exempt)

$108,515 - $152,464 - $196,412

“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

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

  

• Responsible for providing appeal clinical support services to client plan(s) contracting for appeal clinical services.  Support services will include, but not limited to, clinical review, analysis, recommendation, decision, and documentation of appeal requests as required by client contracts, External Review Organization requirements and appeal delegation agreements. 

• Review medication request guidelines for clinical appropriateness and operational efficiency.  Assist in the revision and creation of new or existing medication request guidelines as indicated. 

• Provide drug information support.  Research and provide clinical literature documentation to support prior authorization decisions as indicated.  May include preparation of Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review. 

• Coordinate and assist in the preparation of utilization and compliance reporting for client plans.  Ensure timely preparation and review of plan data and client presentations, when required. 

• Coordinate and assist with projects associated with appeal program development, implementation, and internal and external communications. 

• Provide feedback to Prior Authorization team and Appeals and Grievances Coordinators regarding the processing of appeal cases referred for clinical review. 

Supervisory Responsibilities   

This job has no supervisory responsibilities. 

  

Client Responsibilities 

This is primarily an internal client facing position but may require external client communication from time to time. The incumbent is required to have excellent customer service skills and interpersonal communication skills (listening/verbal/written). 

  

Qualifications   

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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. 

  

Education and/or Experience                                                

Pharmacy degree (Pharm. D.) or equivalent along with 2+ years related experience. 

  

Computer Skills  

To perform this job successfully, an individual should have strong computer skills with Microsoft Office and Microsoft Outlook, good working familiarity with databases and internet searches. 

  

Certificates, Licenses, Registrations   

Current, unrestricted Registered Pharmacist license in the State of Kentucky. 

Other Skills and Abilities                                                       

Excellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment.  Expertise in clinical application of pharmacy