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Pharmacy QA Specialist

18 hours, 20 minutes ago
United States
Full-time
Mid Level
Manual QA Tester
Quality Assurance and Testing
Apply Now
Dane Street

Dane Street

Dane Street provides independent medical examination and peer review services tailored for the insurance industry, focusing on areas such as workers' compensation, disability, and auto liability, while emphasizing quality, compliance, and timely delive...

Insurance
251-1K
Founded 2008
View All Jobs 9

Description

  • Provide regular status updates to PBM clients regarding case progress and completion timelines.
  • Review pharmacy cases for accuracy, completeness, and quality, including medication details, dosing, clinical rationale, and documentation.
  • Ensure determinations align with client policies, formularies, regulatory requirements, and PBM requirements.
  • Coordinate with pharmacists, reviewers, and internal teams to resolve questions, request clarification, and complete addenda.
  • Clarify ambiguous or incomplete client requests and follow up for missing information needed to complete reviews.
  • Distribute final determinations according to client-specific requirements and special handling instructions.
  • Verify adherence to client workflows, including prior authorization, appeals, and exception processes.
  • Provide feedback to pharmacists on documentation quality and completeness.
  • Serve as a subject matter resource on pharmacy benefits, medication reviews, and PBM processes for non-pharmacy QA staff.
  • Ensure final documentation is complete, approved, properly attributed, and released on time.

Requirements

  • Active Pharmacy Technician Certification (CPhT or equivalent) required.
  • State Pharmacy Technician registration/licensure, if applicable, required.
  • Associate or Bachelor’s degree preferred.
  • Experience in a PBM, managed care, pharmacy operations, or healthcare setting required.
  • Experience with prior authorizations, formulary review, or medication review processes required.
  • Strong understanding of pharmacy terminology, medications, and PBM workflows.
  • Ability to interpret clinical guidelines, formularies, and coverage criteria.
  • Excellent written and verbal communication skills.
  • Strong attention to detail, quality standards, critical thinking, and problem-solving abilities.
  • Ability to manage time effectively, meet strict deadlines, and use computer systems and documentation platforms.
  • Reliable high-speed internet connection and a secure, uninterrupted work environment for remote work.

Benefits

  • Medical, dental, and vision coverage for employees and their families.
  • Voluntary life insurance options for employees, spouses, and children.
  • Additional voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance.
  • Basic life insurance, short-term disability, and long-term disability coverage at no cost.
  • Generous paid time off policy.
  • 401(k) plan with company match.
  • Apple equipment and a media stipend provided for remote workspace.

Interested in this position?

Apply directly on the company website

Apply Now

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