Pharmacy Quality Assurance Analyst - Remote

Overview

A detail-oriented and experienced Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with regulatory standards set by CMS and NCQA. This role is critical in maintaining compliance, driving process improvements, and supporting internal and external audits.

In Short

• Evaluate current policies and procedures against CMS/NCQA requirements; identify gaps and recommend improvements.
• Ensure system enhancements and implementations meet business and regulatory needs.
• Develop and deliver training on new CMS/NCQA requirements; administer exams as needed.
• Conduct internal and delegated audits; monitor pharmacy operations and recommend corrective actions.
• Lead recovery efforts for COB, ESRD, Hospice, PDEs, LICs, P2P, and related processes.
• Analyze claims and utilization data to ensure quality controls are in place.
• Reconcile vendor invoices and resolve member/provider issues from Salesforce cases.
• Support PDE management and error resolution processes.
• Oversee FIR and COB backend reconciliation activities.
• Manage monthly quality checks for marketing materials (print and web).

Requirements

• Preferred: Registered Pharmacy Technician & Certification
• Education: Bachelor’s degree or 5+ years of healthcare experience.
• Strong analytical, mathematical, and problem-solving skills.
• Experience with SQL data queries and report generation is a plus.
• Excellent communication and interpersonal skills.
• Bilingual (English/Spanish) preferred.
• Experience With CVS Caremark PBM Reports.
• Business intelligence and comparative analysis.
• Project management and technical writing.
• Ability to manage high-volume workloads professionally.

Benefits

• A competitive salary based on the market
• Medical, Dental, and Vision
• Employer-Paid Life Insurance
• 401(K) match up to 4%
• Paid-Time-Off
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.