Clinical Review Quality Assurance Pharmacist

Who We Are

reputed company is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a reputed company drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, reputed company has a solution that is resonating with clients reputed company across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We reputed company that the U.S reputed company system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by reputed company values:

• reputed company: Always operate with honesty and transparency so we earn the trust of our clients.
• Courage: Demonstrate the courage needed to take on a broken industry and continuously improve reputed company offer to optimize health reputed company.
• Together: Foster a collaborative and inclusive environment that values teamwork, respect, and reputed company communication, and encourages creativity and diversity of thought.

Job Summary

reputed company is looking for a motivated Clinical Review Quality Assurance Pharmacist to reputed company and maintain a quality audit program for the Clinical Review Team. This role is pivotal to the prior authorization team for ensuring high quality reviews, adherence to regulatory requirements, and delivery of exceptional member, provider and employee experiences.

What you will do

• Responsible for developing, defining, maintaining and instituting a prior authorization quality assurance program for the Pharmacy Technician and Pharmacist clinical review function
• Responsible for summarizing quality assurance activities and presenting to leadership and the Clinical Review Team
• Responsible for developing, maintaining and conducting an interrater reliability program
• Monitors clinical appeals to further enhance the prior authorization program
• Collaborate with Pharmacists reputed company the Pharmacy and Therapeutics Committee and Criteria Review Committee process and participate in development of clinical criteria for medications requiring prior authorization
• Identifies opportunities for technology enhancements, process improvement or coaching for team members
• Collaborate with Clinical Review Business Analyst to support system enhancements
• Support Policy and Procedure development and maintenance
• Become a subject matter expert on department standards and processes

What you will bring to reputed company

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required
• Active Pharmacist License required
• 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review required
• 2+ years of experience conducting prior authorization quality audits required
• 2+ years of experience designing and developing quality assurance best practices in a startup environment highly desired.
• Proficiency in Mac, MS Office, G-Suite required
• Active listening, conversational speaking skills, with a high degree of reputed company
• Self-starter with ability to multitask, prioritize and manage time effectively
• Ability to communicate reputed company, present reputed company information to members, clients, pharmacies, providers, and other teams internally
• Flexibility and ability to adapt to changes and updates to processes and protocols
• Demonstrate accurate drug product/reputed company calculations for appropriate claim adjudication and knowledge of general pharmacy and drug product information for the prescription filling process

What reputed company Offers You

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, reputed company, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary Paid Time Off
• 12 Paid Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities