Clinical Quality Pharmacist - Audit & Compliance

MedImpact Healthcare Systems Inc.; San Diego (CA); On-site; USD 109,000 - 196,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness |

Paid Time Off / Company Paid Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. in San Diego, CA is seeking a Clinical Quality Pharmacist to perform audits of PA and Appeals staff and Utilization management across all lines of business.

The role requires a PharmD and 3+ years of experience, with strong knowledge of NCQA/URAC standards and CMS Part D requirements. You will develop audits, analyze results, and report to leadership, ensuring compliance and high quality care.

Qualifications

• PharmD degree and 3+ years’ experience or equivalent combination.
• 1+ years of pharmacy practice in managed care, PBM, or health plan.
• Experience with NCQA/URAC and CMS Part D preferred.

Responsibilities

• Develops and implements clinical audits and reporting for all Client lines of business.
• Evaluates the accuracy of case reviews performed by PA and Appeals staff and UM delegates.
• Creates, administers, and manages IRR testing to ensure consistency amongst reviewers aligned with standards.
• Analyzes IRR results to identify trends, gaps, and opportunities for improvement, and provides detailed reporting to oversight committees.
• Prepares reports (e.g., Utilization Management Program Evaluation, quality reporting suite, IRR).

Skills

Clinical audits

Quality reporting

Regulatory compliance

Communication

Education

PharmD

Managed care exposure

Tools

Microsoft Office

Job description

MedImpact Healthcare Systems, Inc. in San Diego, CA is seeking a Clinical Quality Pharmacist to perform audits of PA and Appeals staff and Utilization management across all lines of business.

The role requires a PharmD and 3+ years of experience, with strong knowledge of NCQA/URAC standards and CMS Part D requirements. You will develop audits, analyze results, and report to leadership, ensuring compliance and high quality care.