Full-Time

Quality Control Operations Manager

Confirmed live in the last 24 hours

MedImpact

MedImpact

1,001-5,000 employees

Compensation Overview

$95.7k - $169.9k/yr

Senior, Expert

No H1B Sponsorship

San Diego, CA, USA

Category
Quality Control & Compliance
Operations & Logistics
Required Skills
SAS
SQL
Data Analysis
Excel/Numbers/Sheets
Requirements
  • Degree from a four-year college or university with strong quantitative skills
  • 8+ years of related experience in areas of statistics or health data analysis or equivalent experience in statistics with pharmaceutical or public health background required
  • Extensive experience using Microsoft Office applications, especially Excel
  • Intermediate to advanced level in SAS
  • Intermediate to advanced level in writing SQL or PL/SQL queries involving multiple table joins and nested queries
Responsibilities
  • Manages the process of evaluating the results of existing quality control processes related to Part D claim adjudication, eligibility and PDEs
  • Maintain models with an eye towards continuous improvement and expansion of capabilities, making recommended changes to Sr Leadership
  • Manages the annual testing associated with the launch of new plan years
  • Execute monthly monitoring and evaluation of all Part D claim adjudications and share findings with appropriate parties for remediation purposes
  • Stay abreast of all Medicare Part D regulatory changes related to PDEs, claim adjudication, eligibility, etc. Update models accordingly for testing of system processes
  • Oversees the annual maintenance and update of existing EGWP pricing model
  • Maintain SAS data necessary for all processes (CMS communication files, Public Use Files, Landscapes, Oracle data, SQL server data, etc.)
  • Identify areas of needed improvement from both a service and financial perspective, share findings with Sr Leadership and assist others with remediation
  • Track findings over time. Develop reporting and metrics to demonstrate the expected continuous improvement of operations and to show areas of strengths and weaknesses
  • Recommends and implements improvements to existing data analytics processes and assist with adoption of new software tools
  • Effectively communicates (written and oral) technical and statistical findings
  • Meets predetermined project deadlines and manages work on multiple projects
Desired Qualifications
  • Knowledge of relational database structures and schemas
  • Knowledge of computer systems and information technology networks
  • Knowledge of statistical analysis, design and interpretation
  • Previous experience working with pharmacy claims data or similar data sets is desired

Company Size

1,001-5,000

Company Stage

Seed

Total Funding

$2.8M

Headquarters

San Diego, California

Founded

1989

Simplify Jobs

Simplify's Take

What believers are saying

  • MedImpact's investment in Bayvrio accelerates healthcare solutions marketplace development.
  • The acquisition of Elixir Solutions enhances MedImpact's pharmacy benefit management capabilities.
  • Partnership with GoodRx lowers drug costs through integrated savings solutions.

What critics are saying

  • Legal disputes with pharmacy networks may harm MedImpact's financial and reputational standing.
  • Acquiring Elixir Solutions from bankrupt Rite Aid poses integration and financial challenges.
  • Regulatory scrutiny over drug pricing could impact the GoodRx partnership.

What makes MedImpact unique

  • MedImpact is the largest independent health solutions and pharmacy benefit management provider.
  • The company offers MedEmpower Fuel[TM], a personalized health approach for chronic condition management.
  • MedImpact integrates GoodRx's price comparison technology for seamless, affordable prescription access.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Wellness Program

Unlimited Paid Time Off

Paid Vacation

401(k) Company Match

Life Insurance

Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Company News

Business Wire
Mar 12th, 2025
MedImpact Investment in Bayvrio Accelerates Development and Launch of Groundbreaking Healthcare Solutions Marketplace

MedImpact Holdings’ strategic investment in health tech startup Bayvrio is accelerating the rollout of Bayvrio’s advanced technology platform and firs

Bloomberg Law
Dec 30th, 2024
MedImpact Sues Pharmacy Network Over Threat to Curtail Contract

MedImpact sues pharmacy Network over threat to curtail contract.

Pharmaceutical Executive
Sep 25th, 2024
Pharma Pulse 9/25/24: Coverage from LogiPharma USA 2024, The Joys of Talking to ChatGPT & more

MedImpact unveiled MedEmpower Fuel[TM], a personalized, integrated, whole health approach to nutrition, weight loss, and chronic condition management.

Business Wire
Feb 2nd, 2024
MedImpact Acquires Elixir Solutions

MedImpact Healthcare Systems, Inc., the nation’s largest independent health solutions, technology, and pharmacy benefit management provider, announced

Drug Store News
Oct 18th, 2023
Rite Aid receives court approval of motions supporting business operations

Additionally, as previously announced, Rite Aid has also entered into an agreement with MedImpact Healthcare Systems, an independent pharmacy benefit solutions company, pursuant to which MedImpact will acquire Rite Aid's Elixir Solutions business.