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 HumanResources@procarerx.com.
ProCareRx is an Equal Opportunity Employer.