Clinical Quality Pharmacist: Audits & Compliance

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

Benefits offered by this job

Medical

Dental

Vision

401K with Company match

Paid Time Off

Job summary

MedImpact Healthcare Systems, Inc. is seeking a Clinical Quality Pharmacist to perform audits of Prior Authorization and Appeals staff, and Utilization review delegates across all business lines.

You will draft, interpret, and modify clinical quality documents to align with regulatory and client requirements. The role supports NCQA and URAC accreditation efforts, develops IRR testing, and provides detailed quality reporting to leadership.

Qualifications

• PharmD and 3+ years' experience in managed care, PBM, or health plan setting.
• Experience with NCQA/URAC accreditation standards and CMS Part D requirements preferred.
• Ability to interpret and prepare clinical quality and compliance reports.

Responsibilities

• Perform clinical audits of PA, Appeals, and UM processes across client lines of business.
• Evaluate accuracy of case reviews and ensure IRR consistency with accreditation standards.
• Develop and deliver audit reports and client-facing quality communications.

Skills

PharmD

Managed care

NCQA/URAC CMS Part D

Quality reporting

Education

PharmD

Tools

Microsoft Office

Outlook

Teams

Job description

MedImpact Healthcare Systems, Inc. is seeking a Clinical Quality Pharmacist to perform audits of Prior Authorization and Appeals staff, and Utilization review delegates across all business lines.

You will draft, interpret, and modify clinical quality documents to align with regulatory and client requirements. The role supports NCQA and URAC accreditation efforts, develops IRR testing, and provides detailed quality reporting to leadership.