Quality Review And Audit Senior Advisor - Express Scripts - Hybrid

Cigna

Multiple Locations, US
Base: 100,000 - 166,600 usd / yearly; bonus/equity...
Clinical accuracy and pharmacy expertise
Regulatory compliance (cms, ncqa)
Benefit configuration validation
The Quality Review & Audit Senior Advisor provides enterprise-level quality assurance leadership with a strong focus on clinical accuracy, pharmacy benefit integrity, and regulatory compliance

Job Summary

  • The Quality Review & Audit Senior Advisor provides enterprise-level quality assurance leadership with a strong focus on clinical accuracy, pharmacy benefit integrity, and regulatory compliance.
  • This role applies advanced clinical and pharmacy expertise to validate benefit configurations, evaluate clinical program performance, and ensure alignment with CMS, NCQA, and state regulatory requirements.
  • The Cigna Group offers a comprehensive range of benefits, including medical, vision, dental, well-being programs, 401(k), tuition reimbursement, and a minimum of 18 days of paid time off per year.

Matching Summary

The Quality Review & Audit Senior Advisor provides enterprise-level quality assurance leadership with a strong focus on clinical accuracy, pharmacy benefit integrity, and regulatory compliance.

Salary

Base: 100,000 - 166,600 USD / yearly; Bonus/Equity: Eligible for annual bonus plan; Benefits: Comprehensive benefits package including medical, vision, dental, 401(k), PTO

Skills & Requirements

Must-have

  • Clinical accuracy and pharmacy expertise
  • Regulatory compliance (CMS, NCQA)
  • Benefit configuration validation
  • Clinical program evaluation
  • Root cause analysis
  • Data-driven insights

Nice-to-have

  • Agile methodologies experience
  • Financial acumen
  • Understanding of healthcare cost drivers

Key Requirements

  • Bachelor's degree strongly preferred
  • Clinical, pharmacy, or healthcare-related background
  • Management experience required
  • Strong analytical and data management skills
  • Advanced Microsoft Office Suite proficiency

Work Rights

Not specified

Tailored Resume

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