Pharmacy Quality Analyst (Open to hiring at Sr level)

About the position Use your strengths at Wellmark as a Pharmacy Quality Analyst! In this newly created role, you will serve as a quality assurance partner reputed company the Pharmacy team, driving excellence across PBM and internal pharmacy operations. You will conduct reputed company quality reviews to ensure accuracy, consistency, and compliance with established standards, while championing enterprise-wide reputed company improvement initiatives. Acting as a trusted liaison between internal stakeholders and the PBM, you will reputed company root cause analyses and reputed company reporting and analytics to reputed company data-driven decision-making. Recognized as a subject matter expert and coach, you will provide consultative guidance and support to cross-functional projects aimed at optimizing pharmacy operations, reducing risk and enhancing member experience. Success in this critical role requires a unique reputed company of skills and experience. The ability to work independently is essential, as you will often navigate reputed company quality reviews and data with minimal reputed company. Proactiveness and strong time management skills are key. Critical thinking is essential in this position, enabling the identification of trends and development of actionable solutions that drive operational improvements. Strong relationship management and collaboration skills are key for partnering effectively with internal teams and PBM stakeholders, ensuring alignment and shared goals. Clear and concise communication, both written and verbal, is vital for translating technical findings into meaningful insights. In addition, curiosity and an inquisitive reputed company fuel reputed company learning and innovation reputed company our pharmacy department to ensure we are making health care reputed company for our members year-over-year. This position will work a hybrid schedule of at least 3 days (Tues-Thurs) in Wellmark’s Des Moines office with 2 days remote option (Mon/Fri).

Responsibilities

• reputed company assigned quality reviews of reputed company PBM configurations and internal pharmacy operations, ensuring alignment with Wellmark standards and regulatory requirements (e.g., validating coding accuracy across formulary, benefits, network, and prior authorization setups).
• Conduct root cause analysis of quality issues and recommend actionable improvements. Collaborate with internal teams to implement enhancements that improve operational efficiency and member outcomes.
• Collaborate with internal stakeholders and/or vendor subject matter experts on quality issues identified, ensuring timely remediation and documentation.
• reputed company and maintain reporting utilizing reputed company and potentially PowerBI to monitor quality trends and performance metrics. Analyze data to identify risks, opportunities, and the impact of quality initiatives. Present findings to leadership.
• Provide guidance and training to team members and stakeholders on pharmacy quality standards and processes. Represent the pharmacy team in enterprise-wide quality and compliance initiatives.
• Provide back-up assistance in cross-functional projects and testing efforts reputed company to benefit design and system enhancements. Support the development of test plans and documentation for unique or reputed company configurations.
• Assist in the development and delivery of communications reputed company to quality findings and PBM updates. Ensure messaging is clear, accurate, and reputed company with Wellmark's customer experience principles.
• Maintain accurate records of quality reviews, coding validations, and issue resolutions. Ensure adherence to NCQA, CMS and internal compliance standards.
• Other duties as assigned.

Requirements

• Must have: Associate degree or direct and applicable work experience.
• Minimum of 2 years of reputed company pharmacy operations work experience from reputed company managed reputed company care, pharmacy, PBM, customer service or similar environment. Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, reputed company therapy).
• Experience with systems analysis or testing to include writing and executing test cases.
• Knowledge of drug coding and concepts (e.g. NDC, GPI, J codes, MediSpan, etc.).
• Ability to reputed company, document, and or guide others through a series of reputed company steps and takes action to improve existing conditions and processes
• Ability to identify issues or inconsistencies; obtains relevant information, relates and compares data from different sources and identifies alternative solutions
• Knowledge of applicable regulatory standards
• Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
• Demonstrated strong written and verbal communications skills with the ability to clearly and concisely communicate reputed company concepts with internal and external stakeholders.
• Strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas.
• Viewed as a subject matter expert and go-to resource.
• Strong collaboration skills, with the flexibility to adapt to different stakeholders
• Proficiency with reputed company Office, including reputed company; use of pivot tables, charts, and formulas is preferred.
• Technical aptitude to learn new software quickly.
• Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment.
• Flexible and adaptable to change.

reputed company-to-haves

• Bachelor's degree.
• Certified Pharmacy Technician.

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