Accreditation, Quality & URL Specialist

“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!

Summary

Responsible for the execution of the annual accreditation and UR assessment process and work plan to maintain MedImpact accreditation and state UR licensure requirements.  Coordinates with internal partners to accomplish assigned accreditation and compliance activities. 

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

• Performs accreditation and quality management related audits and activities with an emphasis on obtaining or maintaining accreditation and UR licensure.
• Participates in onsite audits/reviews, agency inquiries, and training employees, as needed.  Performs ongoing monitoring to ensure the organization is meeting accreditation standards.
• Analyzes data, workflows, policies and procedures to assess program effectiveness.  Interprets significance of routine-intermediate findings to identify areas of improvement, make and implement recommendations for improvement.
• Defines and documents accreditation and compliance process steps (i.e., policy and procedures) in accordance with current state, federal, and independent accreditation and UR licensing requirements.
• Communicates and consults with internal partners to assist with the implementation of accreditation and compliance recommendations for assigned area(s).
• Serves as accreditation subject-matter expert for all or specific program sections, to consult and update internal partners on accreditation efforts and requirements.  May recommend and provide training to employees regarding accreditation and compliance requirements and procedures.
• Stays current with accreditation and regulatory requirements, as well as PA/UM programs in an effort to consult and provide a mutually beneficial resolution.

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 3 years of SME in respective areas

Computer Skills

To perform this job successfully, an individual should have intermediate working knowledge of Microsoft Office Suite (Word/Excel/Access/Outlook) and Adobe Acrobat.

Certificates, Licenses, Registrations

Based on the clinical nature of the work, unencumbered healthcare related license is required.  Examples of applicable licenses include Pharmacy Technician (CPT), Medical Assistant (MA), and/or Registered Nurse (RN).

Other Skills and Abilities

• Experience managing operational projects from inception to completion as well as team leadership and facilitation responsibilities; 
• Ability to gather requirements as well as prepare and maintain detailed product/project plans to support accreditation and quality management activities;   
• Good interpersonal skills with the ability to work independently and as part of a cohesive team;
• Ability to work in a dynamic environment with constantly changing deliverables;

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.

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.

Language Skills

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

• Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization.

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.

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, 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.

• 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.

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.

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.