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

Serves as a recognized Subject Matter Expert (SME) in Quality Management for Fee-for-Service and Medicaid programs. Provides strategic guidance, quality governance, consultation, and oversight to cross-functional teams. Leads complex quality initiatives, drives process improvement, ensures compliance with contractual and regulatory requirements, and influences organizational decisions impacting quality outcomes. Operates with a high degree of autonomy and is relied upon as a key resource for expertise, problem resolution, and quality best practices.

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

Quality Strategy & Governance

• Serve as the designated subject matter expert for Quality Management practices across Medicaid and Fee-for-Service programs.
• Establish and maintain enterprise quality standards, methodologies, and governance frameworks.
• Evaluate emerging regulatory requirements and recommend changes to quality programs, processes, and controls.
• Document Quality Management processes, Standard Operating Procedures (SOPs), and workflow documentation to support operational consistency.
• Establish standardized quality processes across multiple state implementations.

Consultative 

• Provide expert consultation and guidance to operational, implementation, technology, and client-facing teams on quality-related matters.
• Act as the escalation point for complex quality issues, compliance findings, and process deficiencies.
• Influence cross-functional stakeholders and leadership in quality-related decision making.

Root Cause Analysis & Continuous Improvement

• Lead complex Root Cause Analysis (RCA) investigations involving operational, system, and process failures.
• Identify trends and systemic risks through analysis of quality metrics and recommend enterprise-level corrective actions.
• Champion continuous improvement initiatives to enhance quality outcomes, efficiency, and regulatory compliance.

Program Oversight

• Oversee quality management activities across multiple Medicaid implementations and operational programs.
• Review and validate quality deliverables, reports, audits, and corrective action plans developed by other analysts.
• Lead quality readiness assessments for new implementations, major enhancements, and regulatory changes.

Knowledge 

• Develop training materials and facilitate quality education sessions for business and operational teams.
• Serve as a recognized internal resource for quality management best practices.

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

BS/BA and 5+ years’ experience or equivalent combination of education and experience, and 2 years' of SME in respective areas

Computer Skills

Intermediate to advanced skills in Microsoft Office with an emphasis on Word, Excel, MS Access and Project. Intermediate to advanced skills in SQL queries.

Certificates, Licenses, Registrations

None required.

Other Skills and Abilities

• Knowledge of Quality Assurance methodologies and practical application. Ability to research, assess, audit, and apply information to practices and standards. Strong analytical and problem solving ability and in depth understanding of PBM regulations and CMS guidance.

• Demonstrated ability to work in a fast paced environment, learn quickly, appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment. Demonstrate ability to meet or exceed the competencies as listed.

• Healthcare, Managed Care, Government Programs, Fee-for-Service, or PBM Quality experience is preferred

Reasoning Ability                                  

• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

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

Language Skills

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

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

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. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

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.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. 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, 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.