Pharmacy QA Specialist

🕒 August 4

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Coordinate with PBM clients, pharmacists, reviewers, and internal teams to complete pharmacy reviews • Provide clients with status updates on case progress and completion timelines • Evaluate pharmacy reviews for quality, completeness, client-policy, formulary, and regulatory alignment • Ensure determinations include appropriate clinical and/or formulary rationale • Clarify ambiguous or incomplete client requests and follow up for missing information • Distribute final determinations according to client-specific requirements • Manage clarification and addendum requests from clients • Work directly with pharmacists and reviewers to address client questions accurately • Provide feedback to pharmacists on documentation quality and completeness • Review cases for medication details, dosing, clinical rationale, and documentation quality • Ensure compliance with state, federal, and client-specific PBM requirements • Verify adherence to prior authorization, appeals, and exception workflows • Ensure special handling instructions are followed before case release • Serve as a pharmacy subject matter expert and resource for non-pharmacy QA staff

🎯 Requirements

• Active Pharmacy Technician Certification (CPhT or equivalent) required • State Pharmacy Technician registration/licensure, if applicable, required • 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 and quality standards • Critical thinking and problem-solving abilities • Ability to manage time effectively and meet strict deadlines • Proficiency in computer systems and documentation platforms • Prolonged periods of sitting and computer work • Ability to perform standard office functions • Reliable high-speed internet connection • Ability to maintain a secure and uninterrupted work environment

🏖️ Benefits

• Medical, dental, and vision coverage for employees and their families • Voluntary life insurance for employees, spouses, and children • Voluntary hospital indemnity, critical illness, accident indemnity, and pet insurance plans • Basic life insurance at no cost • Short-term disability coverage at no cost • Long-term disability coverage at no cost • Generous paid time off policy • 401k plan with company match • Apple equipment for remote workspace • Media stipend for remote workspace