Judi Health
Healthcare
QualityAssurance(QA)Pharmacist
“Quality Assurance (QA) Pharmacist at Judi Health. Skills: state regulatory knowledge, audit utilization management experience, operationalize regulatory requirements, Microsoft Excel skills, analytical skills, attention to detail, problem-solving abilities. perform routine auditing and monitoring processes to ensure quality, accuracy, and regulatory compliance of coverage requests and appeals. ensure success in annual reporting, program audits, and ad hoc audits”
Industry & Context.
problem-solving abilities; identifying, evaluating, and mitigating operational, and compliance risks
What They're Looking For.
Must Have
Active, unrestricted, pharmacist license required, 2+ years of state regulatory and audit utilization management experience at a PBM or health plan required, Extensive knowledge of how to operationalize regulatory requirements, oral and written communication skills required, Intermediate to advanced Microsoft Excel skills required, Possess analytical skills, attention to detail, quantitative, and problem-solving abilities, 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
Nice to Have
Familiarity/experience with URAC and NCQA accreditation requirements, Utilization management and/or appeals audit experience, 3+ years of compliance or regulatory experience at a PBM or health plan
What You'll Do.
perform routine auditing and monitoring processes to ensure quality
and regulatory compliance of coverage requests and appeals
ensure success in annual reporting
Complete monthly utilization management and appeals performance and process audits in alignment with applicable regulations
accreditation standards
Create and maintain progress reports and audit results in accordance with regulatory/accreditation requirements and internal processes
Present audit results to leadership in a timely manner to address issues and ensure adherence to departmental procedures and regulatory/accreditation requirements (CMS
Continuously review and remain informed of all regulatory/accreditation requirements and updates impacting the coverage request and appeals processes
Respond to inquiries from internal and external stakeholders regarding quality assurance processes
and compliance policies and procedures
Work independently and with team members as warranted by audit assignment
Assist in designing and implementing audit tools and programs
creating QA scorecards and guides in collaboration with all department stakeholders
Provide ongoing performance feedback
to team leads to ensure consistent performance
Assist management in identifying
and mitigating operational
Work in collaboration with operational leaders to identify training opportunities and recommend improvements to Work Instructions
and Policy and Procedures to improve performance
How You'll Work.
Team & Collaboration
Work independently and with team members as warranted by audit assignment; Assist in designing and implementing audit tools and programs, creating QA scorecards and guides in collaboration with all department stakeholders; Work in collaboration with operational leaders to identify training opportunities and recommend improvements to Work Instructions, Job Aids, and Policy and Procedures to improve performance
Communication Scope
oral and written communication skills; Present audit results to leadership
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