Pharmacy Quality & Compliance Analyst

UHS; Reno (NV); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision

401(K) with company match

Career development opportunities

Job summary

Prominence Health, a value-based care organization within Universal Health Services (UHS), is seeking a Pharmacy Quality Analyst. The role focuses on monitoring and improving pharmacy operations, CMS compliance, and PBM performance to benefit members, providers, and partners.

You will work with Pharmacy, Operations, Compliance, Customer Service, and PBM teams to identify issues, analyze data, and implement sustainable corrective actions that enhance efficiency and patient experience.

Qualifications

• Experience in data analysis and auditing in healthcare settings.
• Knowledge of CMS Part D regulations and Medicare Advantage requirements.
• Understanding PBM operations, claims adjudication, prior authorization, and formulary administration.
• Strong communication and technical writing skills for project background and recommendations.

Responsibilities

• Monitor, analyze, audit, and improve pharmacy-related operations across Prominence Health and PBM partner.
• Identify operational breakdowns, compliance risks, service gaps, and inefficiencies affecting members and providers.
• Support continuous improvement initiatives to enhance regulatory compliance and customer experience.
• Develop reports and dashboards to inform stakeholders and drive corrective actions.

Job description

Prominence Health, a value-based care organization within Universal Health Services (UHS), is seeking a Pharmacy Quality Analyst. The role focuses on monitoring and improving pharmacy operations, CMS compliance, and PBM performance to benefit members, providers, and partners.

You will work with Pharmacy, Operations, Compliance, Customer Service, and PBM teams to identify issues, analyze data, and implement sustainable corrective actions that enhance efficiency and patient experience.