Clinical QA Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES Included but not limited to the following:

 Execute QA-related tasks and processes in the Business QA department.
 Provide Specific attention to clinical changes for government programs.
 Review and validate that rules and utilization management along with clinical edits are programmed against
clinical policies accurately.
 Write reports that will produce accurate information needed to validate that clinical changes are accurate.
 Review all material at hand to determine if benefit changes match requests from the client.
 Provide feedback to multiple departments on benefit configuration supporting clinical requests.
 Work with various departments as needed to have plans updated to satisfy requested changes.
 Perform pre and post implementation testing on benefit set up to ensure claims process accurately.
 Document and track testing procedures for new functionality.
 Make presentations to your peers as a department learning tool.
 Miscellaneous duties as requested

QUALIFICATIONS AND REQUIREMENTS:

 Certified Pharmacy Technician with at least 3 years experience required.
 Strong knowledge of pharmacy terminology and medication management to interpret clinical guidelines.
 Quality Control in a HealthPlan setting is preferred.
 Experience in testing system applications and reading results highly desired
 Ability to perform data audits using tools like Excel or SQL.
 Clear concise written and verbal communication skills a plus.
 Ability to multi-taks and adapt to changes as items are reprioritized.
 Familiarity with regulatory or state specific clinical regulations governing pharmacy benefits.
 Knowledge of R&R Reports Works a plus.

PHYSICAL DEMANDS
 Requires sitting, standing, and occasional light lifting.

This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our website for more information about our benefits list.

ProCareRx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [email protected].

ProCareRx is an Equal Opportunity Employer.