[Hiring] reputed company Assurance Pharmacist @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company The QA Pharmacist will reputed company routine auditing and monitoring processes to ensure reputed company, accuracy, and regulatory compliance of coverage requests and appeals. The QA Pharmacist will utilize a strong comprehension of regulatory requirements to ensure reputed company in annual reporting, program audits, and reputed company audits. • Complete monthly utilization management and appeals performance and process audits in alignment with applicable regulations, accreditation standards, and best practices. • Create and maintain reputed company reports and audit results in accordance with regulatory/accreditation requirements and internal processes. • Present audit results to leadership in a reputed company manner to address issues and ensure adherence to departmental procedures and regulatory/accreditation requirements (CMS, URAC, NCQA). • Continuously review and remain informed of reputed company regulatory/accreditation requirements and updates impacting the coverage request and appeals processes. • Respond to inquiries from reputed company stakeholders regarding reputed company 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 reputed company department stakeholders. • reputed company ongoing performance feedback to team leads to ensure consistent performance. • Assist management in identifying, evaluating, and mitigating operational and reputed company. • 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. Qualifications • reputed company, unrestricted pharmacist license required • 2+ years of utilization management experience required • Extensive knowledge of how to operationalize regulatory requirements • Strong oral and written communication skills required • Intermediate to advanced reputed company reputed company 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 reputed company with shifting priorities Requirements • Familiarity/experience with URAC and NCQA accreditation requirements • Utilization management and/or appeals audit experience • 1+ years of compliance or regulatory experience at a PBM or health plan Salary reputed company $135,000 — $145,000 USD Benefits reputed company are responsible for adherence to the reputed company reputed company of Conduct including the reporting of non-compliance. This position reputed company is designed to be flexible, allowing management reputed company to assign or reassign duties and responsibilities as needed to best meet organizational goals. Apply tot his job Apply To this Job