Quality Assurance (QA) Pharmacist

requirements and updates impacting the coverage request and appeals processes. Respond to inquiries from internal and external stakeholders regarding quality assurance processes, audit results, 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, evaluating, and mitigating operational, and compliance risks. 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. Minimum

Qualifications: 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 Strong oral and written communication skills required Intermediate to advanced Microsoft Excel skills required Possess strong 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 Preferred

Qualifications: 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 This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and

responsibilities as needed to best meet organizational goals. #LI-BC1 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 All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and

responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy . Create a Job Alert Interested in building your career at Judi Health? Get future opportunities sent straight to your email. Create alert Apply for this job * indicates a required field Autofill with MyGreenhouse First Name * Last Name * Preferred First Name Email * Phone Country * Phone * Resume/CV * Attach Attach Dropbox Google Drive Enter manually Enter manually Accepted file types: pdf, doc, docx, txt, rtf Cover Letter Attach Attach Dropbox Google Drive Enter manually Enter manually Accepted file types: pdf, doc, docx, txt, rtf LinkedIn Profile Please confirm your City and State * Are you legally authorized to work in the U.S.? * Select... Will you now or in the future require Visa sponsorship? * Select... Are you currently subject to any non‑compete, non‑solicitation, or restrictive covenant that could limit your ability to work for us if hired? * Select... Do you have a Bachelor of Pharmacy (B.S. Pharmacy) or Doctor of Pharmacy (PharmD) degree? * Select... Do you have an active, unrestricted pharmacist license? * Select... Have you ever had any disciplinary action taken against you by any licensing or accreditation organization, including professional board(s)? * Select... What lines of business and funding types do you have experience with? * How many years of experience do you have REVIEWING prior authorizations and/or appeals for a PBM or health plan? * Select... How many years of experience do you have AUDITING prior authorizations and/or appeals for a PBM or health plan? * Select... U.S. Standard Demographic Questions We invite applicants to share their demographic background. If you choose to complete this survey, your responses may be used to identify areas of improvement in our hiring process. How would you describe your gender identity? Select... How would you describe your racial/ethnic background? Select... How would you describe your sexual orientation? Select... Do you identify as transgender? Select... Do you have a disability or chronic condition (physical, visual, auditory, cognitive, mental, emotional, or other) that substantially limits one or more of your major life activities, including mobility, communication (seeing, hearing, speaking), and learning? Select... Are you a veteran or active member of the United States Armed Forces? Select... Voluntary Self-Identification For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file. As set forth in Judi Health’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law. Gender Select... Are you Hispanic/Latino? Select... Race & Ethnicity Definitions If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows: A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to

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