Cms, ncqa, and state regulatory compliance knowledge
End-to-end clinical and pharmacy benefit testing
The Quality Review and Audit Senior Advisor role at Express Scripts focuses on providing leadership in quality assurance related to clinical accuracy, pharmacy benefit integrity, and regulatory compliance. The position requires a strong clinical and pharmacy background, with responsibilities including oversight of benefit configurations, program evaluations, and collaboration with various stakeholders
Job Summary
The role provides enterprise-level quality assurance leadership with a strong focus on clinical accuracy, pharmacy benefit integrity, and regulatory compliance.
Candidates must validate benefit configurations, evaluate clinical program performance, and ensure alignment with CMS, NCQA, and state regulatory requirements.
The position offers an annual salary range of $100,000 to $166,600 USD along with comprehensive health-related benefits starting on day one.
Matching Summary
Match Score: 85
The Quality Review and Audit Senior Advisor role at Express Scripts focuses on providing leadership in quality assurance related to clinical accuracy, pharmacy benefit integrity, and regulatory compliance. The position requires a strong clinical and pharmacy background, with responsibilities including oversight of benefit configurations, program evaluations, and collaboration with various stakeholders.
Salary
Base: $100,000 - $166,600 USD yearly; Bonus/Equity: Eligible for annual bonus plan; Benefits: Medical, vision, dental, 401(k), life insurance, tuition reimbursement, 18+ days PTO
Skills & Requirements
Must-have
Clinical and pharmacy subject matter expertise
CMS, NCQA, and state regulatory compliance knowledge
End-to-end clinical and pharmacy benefit testing
Management experience leading high-performing teams
Advanced proficiency with Microsoft Office Suite
Nice-to-have
Experience with agile methodologies
Financial acumen understanding of healthcare cost drivers
Strong analytical and data management skills
Ability to mentor and train team members
Key Requirements
Bachelor's degree in clinical, pharmacy, nursing, or healthcare field