Job Summary

• The QA Pharmacist will use their state regulatory knowledge to perform routine auditing and monitoring processes to ensure quality, accuracy, and regulatory compliance of coverage requests and appeals.
• Complete monthly utilization management and appeals performance and process audits in alignment with applicable regulations, accreditation standards, and best practices.
• Present audit results to leadership in a timely manner to address issues and ensure adherence to departmental procedures and regulatory/accreditation requirements (CMS, URAC, NCQA).

Matching Summary

Salary

Base: $135,000 - $145,000 USD; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Key Requirements

• Active, unrestricted, pharmacist license
• 2+ years state regulatory and audit utilization management experience
• Extensive knowledge of operationalizing regulatory requirements
• Strong oral and written communication skills
• Intermediate to advanced Microsoft Excel skills
• Strong analytical skills
• Ability to work independently
• Ability to multi-task and collaborate

Work Rights