other
Posted May 4Quality Assurance (QA) Pharmacist
at Judi Health
Remote
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Responsibilities
- Create and maintain progress reports and audit results in accordance with regulatory/accreditation
- 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).
Requirements
- Judi® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
- 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.
- The QA Pharmacist will utilize a strong comprehension of regulatory
- experience at a PBM or health plan required
- Extensive knowledge of how to operationalize regulatory requirements
- Intermediate to advanced Microsoft Excel skills required
- Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven work environment
- Ability to multi-task and collaborate in a team with shifting priorities Preferred
- Familiarity/experience with URAC and NCQA accreditation requirements
Experience
- 2+ years of state regulatory and audit utilization management
- 3+ years of compliance or regulatory experience at a PBM or health plan
Benefits
- This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
- Remote, US Salary Range $135,000 — $145,000 USD