Clinical Account Executive II

Responsibilities

Leads clinical account work for state Medicaid clients, monitoring service commitments and recommending evidence-based benefit, formulary, and utilization strategies to improve clinical quality and reduce net costs. Coordinates clinical analyses, client presentations, implementation support, and P&T participation while guiding junior team members and aligning account initiatives with client and company goals.

Requirements

Requires a PharmD and at least five years of experience, or an equivalent combination of education and experience, including three years as a subject matter expert in the relevant area. Candidates must hold a pharmacist license in good standing and be able to obtain any required state license within six months, with analytical, communication, drug-information, and business-intelligence tool skills.

Skills

• Medicaid Pharmacy Coverage
• Account Management
• Clinical Project Management
• Pharmacy Benefit Management
• Drug Utilization Management
• Clinical Quality Improvement
• Cost-Effectiveness Analysis
• Preferred Drug List Analysis
• Utilization Management Criteria Development
• Pharmacy and Therapeutics Committee Support
• Service Level Agreement Monitoring
• Data Analysis
• Client Consultation
• Team Leadership
• Microsoft Office
• IBM Cognos or Tableau

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Wellness Programs
• Paid Time Off
• Company-Paid Holidays
• Incentive Compensation
• 401(k) With Company Match
• Life Insurance
• Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

About this role

Exemption Status:
United States of America (Exempt)
$128,974 - $183,144 - $237,313
“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
The Clinical Account Executive (CAE) II possesses an exceptional working knowledge of Medicaid program pharmacy coverage and payment rules, along with in-depth experience in managing accounts and clinical projects. This position is dedicated to optimizing the clinical quality and cost-effectiveness of drug therapy for a state Medicaid agency and its members. The role focuses on the rational management of drug utilization, employing analytical tools and an evidence-based approach to achieve lower net costs, better health outcomes, and high levels of satisfaction for plan sponsors and their members.
In addition to account/contract management responsibilities, the CAE II serves as both the subject matter expert and the team lead for specific account(s). The CAE II provides guidance, coordinates tasks, and when necessary, delegates tasks among junior team members to ensure service levels meet client expectations. This position collaborates with corporate resources to achieve overall account and company financial goals. It relies on data and performance indicators, along with experience and judgment, to identify and promote performance improvement opportunities that meet the aligned goals of MedImpact and the client.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
· Serves as team leader for specific account(s), providing guidance, coordinating tasks, and delegating tasks among junior team members when necessary to ensure service levels meet client expectations.
· Monitors contractual Service Level Agreements (SLAs) related to clinical services for managed account(s) and reports to leadership if risks are observed.
· Provides recommendations to assigned clients that align with the clients' goals of achieving lower net costs and high clinical quality. Strategic recommendations may include benefit design and Preferred Drug List (PDL) analysis and suggestions, provision of clinical drug information, utilization management criteria development, Pharmacy & Therapeutics (P&T) support and participation, recommendations for rational drug PDL positioning, online system edits and restrictions, ongoing clinical product evaluations, and recommendations regarding client pharmacy benefit utilization and performance trends.
· Offers clinical and Medicaid consultative services in accordance with contracted services. Acts as an integral part of designing, developing, and driving the clinical components of the assigned account team's strategic and financial goals. The CAE II focuses on using a variety of analytical tools and clinical resources to identify opportunities that simultaneously improve the plan sponsor's quality-focused and financial performance metrics.
· Identifies and promotes MedImpact's evidence-based interventions and communication programs to clients, providing documentation of recommendations for clinically appropriate and financially beneficial clinical initiatives (e.g., rebate enhancement, lower net cost, generic programs, QA programs).
· Recommends clinically appropriate PDL changes, considering the lowest net cost after rebates, market shifts, and utilization.
· Coordinates clinical utilization analyses and presentations to clients, ensuring timely and accurate review of plan data according to policy and offering appropriate intervention recommendations.
· Coordinates the clinical support of Preferred Drug Lists during plan sponsor implementation.
· Participates in quarterly state P&T meetings as stipulated by client contracts.
Supervisory Responsibilities
No supervisory responsibilities
Education and/or Experience
PharmD 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 knowledge of Microsoft Office Suite and experience with at least one business intelligent tool (IBM Cognos or Tableau preferred).
Certificates, Licenses, Registrations
Registered Pharmacist license in good standing and the ability to obtain licensure in specific state as necessary within 6 months.
Other Skills and Abilities
Familiar with First Databank and Medi-Span drug information.
Analytical skills required to perform drug cost expenditure impact analysis.
Exceptional communication skills and interpersonal skills to interface with clients and internal team members.
Reasoning Ability
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete varia...

About MedImpact Healthcare Systems, Inc.

Hospitals and Health Care · 1,001-5,000 employees · headquartered in San Diego, CA · founded 1989