Jobs at MedImpact Healthcare Systems

Manage onboarding and implementation of new PBM clients, coordinate cross-functional teams, ensure claims adjudication accuracy, document and test configurations, track project milestones in Salesforce, communicate client expectations, resolve issues, ensure regulatory compliance, and transition clients to maintenance while supporting process improvements and training.

Processes prior authorization requests for a pharmacy benefit manager, entering and documenting data, reviewing formulary alternatives and medication history, and making determinations under established guidelines. Coordinates with pharmacists, members, physicians, pharmacies, clients, and internal teams to obtain missing information, communicate status, resolve issues, and meet accuracy and turnaround requirements. Maintains confidentiality of member and authorization information while providing customer support.

Processes pharmacy prior authorization requests according to client guidelines, turnaround times, and accuracy standards. Reviews formulary alternatives and medication history, enters and documents authorization data, communicates determinations, and obtains missing information from members, providers, pharmacies, and clients. Coordinates with clinical pharmacists and client teams, resolves processing issues, handles inquiries, and protects confidential member information.

Leads rebate economics, forecasting, financial reporting, dashboards, controls, audits, and performance optimization for Trade Relations. Analyzes large datasets to identify rebate opportunities, manages cross-functional improvement initiatives, ensures accurate and timely deliverables, and presents results to senior leadership. The role supervises staff, manages client relationships, supports financial audits, and drives KPI development and operational improvements across the pharmacy benefit management organization.

Conduct clinical reviews of pharmacy and medical therapy appeals, evaluate medical records against clinical criteria, and make benefit coverage determinations. Research drug information and literature, support medication guideline development, prepare utilization and compliance reports, assist with formulary and Pharmacy and Therapeutics materials, and contribute to appeal program projects. The role ensures accurate, timely, cost-effective, and regulatory-compliant decisions while supporting internal and external clients.

Processes healthcare appeals and grievances accurately and within regulatory and client-mandated timelines. Evaluates requests, conducts outreach by phone and fax, documents activities, communicates decisions, protects member health information, and cross-trains across processing functions. Provides internal and external customer support, adapts to changing business needs, participates in weekend on-call rotations, and may work overtime, nights, weekends, or holidays.

Manages pharmacy audit and fraud, waste, and abuse operations, including audit program design, compliance, investigations, reporting, staff development, budgeting, and client support. Leads desk and on-site audits, ensures regulatory and contractual compliance, oversees pharmacy credentialing support, analyzes operational data, and drives process improvements. Provides cross-functional leadership, manages assigned staff, supports regulatory examinations and client implementations, and ensures timely, accurate service delivery.

Manages complex health plan and PBM client accounts, strategic plans, revenue targets, renewals, upsell opportunities, service delivery, and client satisfaction. Leads internal account teams, oversees client initiatives and implementations, supports negotiations and sales presentations, analyzes financial and clinical scenarios, and develops executive-level client relationships. Requires Medicare Part D knowledge, strong consultative selling, negotiation, presentation, analytical, and communication skills. Domestic travel may reach 35%.

Process and finalize prior authorization requests per client guidelines and turnaround times. Use Windows-based systems and drug references to verify medications, document decisions, communicate with providers/pharmacies/members, resolve pended requests, and collaborate with clinical pharmacists and client teams to meet productivity and accuracy standards.

Manage Trade Emerging Markets activities across Trade Relations to assess pricing, rebate, reporting, and formulary impacts. Coordinate cross-functional stakeholders, track milestones and risks, document decisions, develop repeatable processes and communication, and supervise staff to ensure accurate, timely execution of emerging market product strategies and market-event responses.

Lead development and management of rebate analytics and reporting strategies across the enterprise. Deliver pricing transformation, client-facing financial analysis, KPIs, stakeholder management, and supervise staff to ensure accurate, timely rebate and client financial reporting and strategic recommendations.

Lead underwriting and economic strategy for complex trade and emerging market initiatives. Develop business cases, financial models, pricing and margin analyses, and underwriting frameworks. Partner cross-functionally and with vendors to align contracts, implementation readiness, and performance tracking. Provide executive recommendations, run cross-functional workgroups, and manage a team with responsibility for coaching, prioritization, and performance management.

Lead rebate economics, pricing strategy, financial analytics, and client reporting. Partner with executive leadership and cross-functional teams to develop pricing methodologies, optimize revenue, mentor analytics staff, and support business growth through financial evaluation and strategic initiatives.

Lead clinical account management for state Medicaid pharmacy clients, optimizing drug utilization and net costs through evidence-based interventions, PDL and P&T support, utilization analyses, and coordination of clinical initiatives to meet client and company goals.

Lead territory sales activities to achieve revenue targets through prospecting, proposals, RFP management, pricing, negotiations, and onboarding. Build broker/consultant relationships, maintain CRM, collaborate cross-functionally (analytics, contracts, account teams), and represent MedImpact in the market to drive profitable growth and successful client implementations.

Lead and manage client onboarding, implementation, and ongoing account servicing to ensure service levels, resolve issues, analyze claims, coordinate cross-functional teams, drive client satisfaction and retention, and deliver revenue growth.

Conduct quality audits of customer service, claims, and prior authorization interactions; provide call coaching, training, and feedback; analyze quality scores and trends; recommend workflow and training improvements; support Help Desk and occasional client-facing tasks; prepare reports and training materials to improve customer service performance.

The Clinical Operations Pharmacist verifies and dispenses mail-order prescriptions, supports pharmacy technicians and fulfillment staff, contacts patients and providers, transfers prescriptions, researches drug literature, counsels patients, and provides clinical recommendations. The role also reviews medication requests for prior authorization, supports clinical projects, maintains current knowledge of pharmacy laws and practices, and delivers effective client service. This is an on-site, full-time position in Fremont, Nebraska, requiring occasional overtime but no travel.

The Principal, Digital Product Management leads product strategy and execution, overseeing the development lifecycle, ensuring successful product performance and alignment with corporate goals.

Full-cycle recruiter responsible for sourcing, screening, interviewing, and hiring talent. Partners with hiring leaders to build recruiting strategies, manage ATS workflows and offers, support compliance and reporting, represent the employer at events, and improve sourcing and time-to-fill metrics.