Clinical Quality Pharmacist — Audit & Compliance Lead

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

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off / Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. seeks a Clinical Quality Pharmacist responsible for auditing Prior Authorization, Appeals, and Utilization Management processes, ensuring regulatory and accreditation compliance.

You will draft and align clinical documents, reports, and quality metrics across all client lines of business. The role requires PharmD with 3+ years in managed care or health plan settings, including NCQA/URAC/CMS knowledge.

Qualifications

• PharmD and 3+ years’ experience or equivalent combination of education and experience.
• 1+ years of pharmacy practice experience in utilization management, clinical quality, or accreditation.
• Experience with NCQA and/or URAC accreditation standards and CMS Part D is preferred.

Responsibilities

• Perform clinical audits of PA, Appeals, and UM staff across lines of business.
• Interpret, draft, and modify clinical documents and quality reports per regs and client requests.
• Develop and administer inter-rater reliability testing to ensure reviewer consistency.
• Monitor PA/Appeals processes for improvement opportunities and report to leadership.
• Prepare audit reports and quality metrics for oversight committees.
• Support accreditation readiness and client-facing quality communications.
• Assist with process improvements and automation to enhance quality.

Skills

Clinical audits

Quality improvement

Regulatory compliance

Data analysis

Documentation & reporting

Education

PharmD

3+ years managed care/pharmacy experience

NCQA/URAC/CMS knowledge

Tools

Microsoft Office

Teams

PDF tools

Job description

MedImpact Healthcare Systems, Inc. seeks a Clinical Quality Pharmacist responsible for auditing Prior Authorization, Appeals, and Utilization Management processes, ensuring regulatory and accreditation compliance.

You will draft and align clinical documents, reports, and quality metrics across all client lines of business. The role requires PharmD with 3+ years in managed care or health plan settings, including NCQA/URAC/CMS knowledge.