Meridian

  • Pharmacy Medical Director

    Job Location US-MI-Detroit
    Job ID
    2018-6898
    Category
    Pharmacy
    Business Line
    MRx
  • Overview

    Who we are:

    MeridianRx is a full-service Pharmacy Benefit Manager (PBM) committed to driving down costs and elevating quality. Our clients experience better quality outcomes, thanks to effective clinical support, patient education, and specialty pharmacy programs.


    We work with a diverse range of clients, from members to healthcare providers to plan administrators. MeridianRx services clients across the country and our network continues to grow.


    Our employees work hard, play hard, and give back. MeridianRx employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day in the Life of a Pharmacy Medical Director:

     

    This position provides oversight of the Utilization Management process and supports other areas of the managed care organization such as formulary development, quality improvement, and clinical program development.

    Responsibilities

    • Provide clinical leadership for the utilization management process, including authorizations, denials and appeals. Offer clinical guidance to the Utilization Management pharmacists and other staff
    • Respond to provider inquiries regarding utilization management decisions, complaints and appeals. Promote positive provider relationships
    • Offer clinical insight for the development or adoption of utilization management, care coordination, pharmacy and quality improvement programs, as well as medical policy and criteria development
    • Review practice patterns of physicians and work with the Chief Compliance Officer to identify potential for Fraud Waste and Abuse (FWA) and to report these findings to the Corporate FWA Committee
    • Investigate complaints from members regarding possible quality of care concerns
    • Serves on internal committees such as credentialing, medical polices, and others as assigned.
    • Coordinate with the Chief Medical Officer, the Pharmacy Director and other staff to ensure appropriate administration of the pharmacy benefit
    • Oversee staff training and education in matters relating to the delivery of medical care, the assurance of quality, and effective control of utilization
    • Work with the Chief Medical Officer to assure quality of care in all aspects of drug utilization and to assure that utilization is appropriate to meet the needs of the members
    • Maintain compliance with all regulatory programs including National Committee for Quality Assurance (NCQA), URAC and/or general accreditation and State Medicaid guidelines
    • Represent the health plan and pharmacy benefit manager in the medical community, upon request
    • Perform other duties as assigned

    Qualifications

    What you can bring to Meridian:

    • Current unrestricted license as Doctor of Medicine or Osteopathy is required
    • Current board certification in his or her designated specialty is required
    • 5 years Post Graduate experience in direct patient care
    • Quality improvement and/or teaching experience is preferred
    • Experience in providing care to underserved populations is preferred
    • Strong medical knowledge including evidence based medicine
    • Knowledge of quality improvement activities
    • Strong team-building skills; able to foster effective interactions across organizational and departmental boundaries
    • Strong, professional presentation skills; able to present organizational objectives, ideas, and/or concepts in a convincing and credible manner
    • Intermediate computer skills necessary
    • Ability to work independently and prioritize workload
    • Ability to work with colleagues and other health care professionals to resolve issues as required
    • Demonstrated commitment to ensure that clinical programs are culturally sensitive and linguistically competent
    • Ability to communicate effectively with health professionals and administrators, both orally and in writing

     

    What Meridian can offer you:

    • Healthcare benefits that include a variety of plans, which are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • 401k matching that is above the national average.
    • Full-time MeridianRx employees are eligible for tuition reimbursement towards Bachelor’s or graduate degrees.
    • A bright and engaging company culture; the Meridian family of companies has been recognized as one of Metro Detroit’s Best and Brightest Companies to Work For 5 years in a row.

    Equal Opportunity Employer

    #MSTR

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