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

Summary

The PA Audit Pharmacist serves as the clinical subject matter expert for PA audits, with responsibilities focused primarily on audit preparation, participation, and response.   This employee understands every aspect of the MedImpact PA program. Reports directly to the Director, External Audit team, and works closely with other audit pharmacists and team members to ensure coordinated, accurate, and timely audit deliverables.

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

• Serves as the clinical Subject Matter Expert (SME) for all Medicare Part D audits by CMS (Centers for Medicare & Medicaid Services).
• Serves as the client-facing pharmacist for all PA audit issues and client oversight, collaborating with other members of the PA Audit team.
• Assists the PA Audit team with the initiation, participation, progression, and completion of CMS client PA audits and other regulatory or quality PA audits as needed.
• Assists Appeals Team, Prior Authorization Team, and Clinical Guideline Team, as needed, for audit or regulatory related topics.
• Collaborates cross-functionally with other members of the External Audit team, particularly other audit pharmacists, to ensure consistent, accurate, and timely audit responses across all pharmacy audit areas.
• Coordinates the collection, validation, and submission of audit evidence to ensure alignment with regulatory requirements and client expectations.
• Monitors audit timelines and milestones to ensure deliverables are met and escalates potential risks to leadership proactively.
• Analyzes audit requests and findings to identify patterns, potential areas of exposure, and opportunities for process improvement.
• Provides subject matter expertise to internal teams during audit preparation, including reviewing clinical decision-making and documentation for accuracy and compliance.
• Maintains current knowledge of CMS audit protocols, regulatory updates, and industry trends to ensure audit responses reflect the most up-to-date standards.
• Participates in post-audit debriefs and contributes to lessons-learned documentation to strengthen future audit performance.
• Other duties as assigned.

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 accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas

Computer Skills

Knowledge of Microsoft Office Suite, including Teams, and a working knowledge of relational databases.  Expert user of MedResponse, MedAccess, and MedOptimze,; or expertise in another PBM PA and Claim platforms.

Certificates, Licenses, Registrations

Current, unrestricted license as a registered pharmacist within at least one state in the United States is required.

Other Skills and Abilities

• Strong ability to work with complex systems and analyze data for trends.
• Analytical skills.
• Experience promoting disease management or drug cost management programs preferred.
• Ability to calculate and/or interpret market shares and graphs.
• Strong understanding of medication dosing.

Reasoning Ability

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. 

Mathematical Skills

•  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. 

• Ability to write reports, business correspondence, and procedure manuals. 

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Requires close vision (clear vision at 20 inches or less).

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonably meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, at weekends or on holidays as required.  Work hours may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires no travel; however attendance may be required at various local conferences and meetings.

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.