Pharmacy Utilization Management and Quality Assurance Leader - Remote

Overview

The Pharmacy UM/QA Leader oversees pharmacy and medical drug Utilization Management delegates, ensuring quality assurance and compliance with pharmacy regulations.

In Short

• Provide oversight of pharmacy and medical drug UM delegates.
• Ensure quality assurance by reviewing cases daily.
• Identify and address inappropriate determinations.
• Collaborate with Pharmacy Operations to resolve challenges.
• Develop clinical QA methodologies.
• Monitor KPIs with the Analytics & Audit team.
• Review appeals before submission to IRO.
• Direct management reporting on productivity and compliance.
• Lead quality standards for UM functions.
• Weekend coverage for emergencies.

Requirements

• Doctor of Pharmacy degree or Masters in Pharmacy.
• Registered Pharmacist with NY or CT license.
• 10+ years of relevant business experience.
• Minimum of 2 years of management experience.
• 5 years of pharmacist experience.
• Utilization Management experience required.
• Knowledge of pharmaceuticals and disease states.
• Research and analytical skills.
• Excellent verbal and written communication skills.

Benefits

• Payday Fridays.
• Dental and Vision Insurance.
• Short-term and Long-term Disability Insurance.
• Voluntary Life & AD&D Insurance.
• Health Advocate EAP.
• 401k Plan.
• Commuter Benefits.
• Access to ZayZoon.
• Critical Illness and Hospital Indemnity Insurance.