Cms Empregos à distância e ao domicílio em San Diego, CA ∙ Página 1

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

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

• Develops strategic goals, objectives and plans related to department and company government programs strategy. Evolves strategic recommendations regarding infrastructure, business development, budget and pricing in conjunction with various teams within and outside GPS.

• Oversees and controls the planning, staffing, budgeting, as well as managing resource expense priorities; approves changes to methods and practices.  Recruits, manages, and retains the necessary leadership to successfully perform the duties for the business unit.  

• Leads the development and implementation of short and long-term strategies to increase new government program business. Maintains awareness of current and future marketplace trends, including the regulatory environment, customer needs, opportunities and issues. Transforms knowledge into results-generating strategies and business development plans.

• Ensures that resources, infrastructure, processes and programs are in place for the efficient execution of business objectives. Directs policies, programs, systems and procedures to meet operational, financial and service requirements for government programs.

• Works closely with the company’s Corporate Compliance Officer. Coordinates the implementation and maintenance of federal and state government compliant programs. Reviews and interprets current and future laws, rules, and regulatory requirements, develops relationships as necessary with state, federal, and regional stakeholders for purposes of educating oneself and internal staff members.  

• Coordinates with MG Insurance leadership (and other subsidiary/summit company leadership).  Oversees the effort to provide PDP Services for MedImpact Group (EGWP) and Individual PDP products. 

• Manages the Center for Medicare & Medicaid Services (CMS) relationship and adheres to contractual requirements, budget, underwriting, operations, vendor management, beneficiary and customer service and financial performance of the PDP Product. 

• Actively participates in the PBM sector policy advocate associations to understand and influence PBM industry-wide public policy decision making. Represents the organization in matters involving the federal and state by providing policy direction and overseeing operational efforts.

• Serves as the internal spokesperson for government programs. Develops, communicates and builds commitment to organizational policies, directives, and procedures and programs. Collaborates with the management team to ensure that required information is communicated throughout the organization.  

• Builds strong customer relationships. Represents MedImpact to key government customers as well as MedImpact’s clients. Ensures an effective, positive representation of the corporate image.  

• Evaluates performance of direct reports for compliance with established policies and objectives, leadership competencies and contributions in attaining objectives. Develops and monitors succession planning process for top leadership positions.

• Supports business development activities to enable the company to grow its State Medicaid FFS business.  Serves as a company representative to key government customers and prospects.

• As the business owner of specific/multiple clinical initiatives, at any stage of the product development lifecycle, this individual must be prepared to step in at any stage of product development, and assist the designated teams in the completion of their tasks within the project timelines and within the allocated budget.

• As the business owner of specific business initiatives related to State Medicaid FFS programs, this individual creates Charters and documentation for the successful introduction, defense, and acceptance of a product development or project development requirement through the company’s Enterprise Product/Project Prioritization (EPP) process.

• Supports MedImpact’s State Medicaid FFS Implementation team as new contract are awarded. 

• Drives networking activities; participates in conferences, speaking opportunities, for regulated markets.

• Assists the Sales department in the development and execution of short and long-term strategies to increase new government program business. Maintains awareness of current and future marketplace trends, including the regulatory environment, customer needs, opportunities and issues. Transforms knowledge into results-generating strategies and business development plans.

• Acts as the Executive Sponsor for new sales opportunities, participating in finalist meetings to demonstrate the value proposition of Medicare, Medicaid, Market Place, State Medicaid Fee for Service and the Prescription Drug Plan and win new business.

• Assists the sales process for State Medicaid FFS and actively participates in proposal response development, prospect meetings and best and final presentations.

• Serves as a key subject matter expert (SME) regulated markets based on interpretation of State and Federal regulations.  

• Maintains a thorough understanding of the company’s programs and services provided to Medicare, Medicaid, MMP, Marketplace, Medicaid State Fee for Service and the Prescription Drug Plan customers.  Provides direction on the potential impact of new or potential regulatory requirements relative to these business lines. Works with key business units to drive change regarding complex regulatory and legislative issues that impact MedImpact’s business services and operational processes.

• Reviews new/pending legislation and regulatory materials relative to Medicare, Medicaid, MMP, Marketplace, Medicaid State Fee for Service and the Prescription Drug Plan with an emphasis on prescription drug management. 

• Builds strong client, industry consultant and vendor relationships. Develops relationships with federal/ state agencies and other key stakeholders.  Determines gaps in the Company’s services and relationships as well as develops and drives associated corrective action plans (CAPs) to improve client/partner relationships. 

• Keeps current with the industry’s best practices; seeks job related seminars to keep up-to-date as well as continuously upskill.

Supervisory Responsibilities        

Manages assigned staff in Government Programs & Services departments. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary.

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                                             

Bachelor’s degree (or equivalent combination of education and experience); Advanced degree preferred (Ph.D., MBA, M.S., MPA, MPH) along with 15+ years’ progressive experience in PBM, Managed Care Organization and/or State Medicaid or Marketplace Agency. Must have in-depth knowledge of governmental programs (CMS, Medicaid, Medicare, and Marketplace/Public Exchanges) and at least 15+ years’ experience in a leadership capacity, supervising and leading individuals, teams, and subject matter experts in the field.  Prior work experience within the CMS a plus.  Experience leading a MA-PD or PDP plan a plus.  

Computer Skills

Solid computer skills with Microsoft Office/Outlook, industry-related databases and use of the internet.

Certificates, Licenses, Registrations

None Required

Other Skills and Abilities                                                    

• Practical working knowledge of State Medicaid FFS programs, Federal Employee Programs, State Employee programs, Medicaid, CHIP, PIHP, PAHP, PCCM, HIO, Dual Eligible, Part D, Exchange, Basic Health Plans, SNP.
• Expert knowledge of operations management for a corporation in the managed health care, Medicare/Medicaid/Marketplace and other government programs, preferably with a PBM at the senior level.

• Ability to scan and anticipate policy, regulatory and legislative activity for upcoming issues that may impact the industry.

• Good public speaking abilities with the ability to present to large audiences; excellent communication (verbal and written) skills, interpersonal skills, and organizational skills a must.
• Ability to present controversial or complex topics to upper management, public groups, and/or boards of directors.

• Able to lead multiple disciplinary teams to accomplish short-fused, technically focused product development or project management tasks that will lead to the efficient and effective growth of the company’s business.                                           
• Strong analytical and critical thinking skills.  Must possess strategic agility and effective communication skills.

Reasoning Ability                                                    

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.       

Mathematical Skills                                                 

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.  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.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Competencies                                               

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

• Business Knowledge - Demonstrates clear understanding of the nature of the business -- its products and services, goals, market, competitors and challenges. 

• Communication - Expresses self clearly and effectively in face-to-face interactions, presentations and written documents, and employs active listening skills to ensure productive interactions.

• Decision-making - Gathers input from affected parties and available experts, assesses risks and benefits, and makes timely decisions based on sound reasoning.

• Leadership - Leads effectively by communicating long-range vision, exercising influence, building strong teams, mentoring and motivating others, and upholding corporate responsibility.

• Financial Acumen - Demonstrates accurate understanding of financial measurements and documents, how his/her actions affect the company’s bottom line, and what must be done to keep profits and cash flow healthy.

• Political Savvy - Recognizes issues of power and politics that may impact a project or decision and handles them with diplomacy and ease; skillfully deals with roadblocks in order to facilitate progress while maintaining good working relationships.

• Professionalism - Acts with integrity, shows self to be reliable and responsible, displays emotional intelligence, and conscientiously complies with all relevant laws, policies, and procedures.

• Strategic Vision - Formulates and communicates a long-range, big-picture vision, taking into account both opportunities and challenges, and translates that vision into specific action steps.

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 accommodations 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. The employee is frequently required to use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Work Location

This position is remote.

Working Hours

This is an exempt level position requiring one to work the hours needed to get the job done.  Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  This 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 domestic travel of up to 10% - 20% of the time. 

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.