It`s fun to work in a company where people truly BELIEVE in what they`re doing!

We`re committed to bringing passion and customer focus to the business.

Lead monthly formulary changes and new year’s benefit set-up implementation, testing and validation.

Perform internal monthly audits to the Pharmacy Department and related PBM operations, as defined by the department to ensure alignment with CMS requirements.

Present audit results to Pharmacy leadership and Compliance, and propose and implement corrective actions, as needed.

Assess current policies and procedures against CMS requirements, identify gaps, and implement process improvements.

Generate Data Validation Audit (DVA) Universes and support the DVA overall audit process in accordance with regulatory CMS protocols.

Support call monitoring and identify training needs for the personnel using product and benefit knowledge.

Conduct constructive coaching/feedback sessions:

Utilize a coaching form (developed as a subset of the monitoring sheet) to provide coaching feedback to the Team Leaders, Supervisors and Department Directors.

Utilize established criteria for identifying opportunities for coaching.

Communicate/elevate identified unresolved issues to the appropriate supervisor as needed.

Coordinates/advocates resolution of member pharmacy issues, concerns, and grievances.

Generate J Codes, diagnosis, and services reports in the corresponding timeframes.

Support CMS audits and NCQA accreditation (Gather universes and evidence among others).

Act as back-up for the Audit and Quality Assurance Data Analysts as needed.

If you like wild growth and working with happy, enthusiastic over-achievers, you`ll enjoy your career with us!