Exemption Status:

United States of America (Exempt)

$95,717 - $132,808 - $169,898

“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.

1. AI/ML Solution Discovery & Requirements

• Partner with IT and business teams to identify high-impact AI/ML opportunities, such as Prior Authorization Automation (NLP for clinical review acceleration), Fraud/Waste/ Abuse Detection (anomaly detection models), Drug Recommendations (predictive analytics for formulary optimization).
• Translate business needs into technical AI/ML requirements (data, algorithms, success metrics).    
   

2. Data and Model Governance

• Define data pipelines for AI training (Prior Authorization Guideline documents, claims, EHR, pharmacy, and eligibility data).  
• Ensure compliance with HIPAA and PBM industry regulations in AI model development.  
• Implement bias detection, explainability, and model performance monitoring frameworks.  

Cross-Functional Collaboration  

• Bridge business teams and IT data science and engineering.  
• Develop ROI analyses to prioritize AI/ML initiatives based on impact and cost.  
• Lead user acceptance testing (UAT) and change management for AI integration and adoption.  
   

AI/ML Lifecycle Support

• Document use cases, feature definitions, ethical, security and compliance considerations.  
• Monitor model performance in production (accuracy, drift, business impact).  
• Optimize human-in-the-loop workflows for AI-assisted decision-making.
   

Supervisory Responsibilities

No supervisory responsibilities

                                               

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

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

BS/BA and 6+ years’ experience or equivalent combination of education and experience, and 2 years' of SME in respective areas.

Computer Skills

• Strong SQL and Python skills (data analysis, feature engineering basics).  
• Familiarity with PBM business model (plans, programs, and practices) as well as pharmaceutical practices (nomenclature, medications.  
• AI/ML literacy (understanding of supervised/unsupervised learning, NLP, LLMs).  

Certificates, Licenses, Registrations

None Required

Other Skills and Abilities

• Regulatory knowledge: HIPAA, AI ethics frameworks (e.g., NIST AI RMF).  
• Ability to analyze complex data flows and identify root causes of issues.  
• Excelle