Pharmacy Quality & Compliance Analyst

Universal Hospital Services Inc.; Reno (NV); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Generous Paid Time Off

Competitive compensation

Excellent Medical, Dental, Vision and

401(K) with company match

SoFi Student Loan Refinancing

Career development opportunities

Job summary

Prominence Health, part of Universal Health Services, seeks a Pharmacy Quality Analyst to monitor and improve pharmacy operations across Prominence Health and its PBM partner. This role identifies compliance risks, service gaps, and process inefficiencies affecting members, providers, pharmacies, and brokers.

Under the VP Health Services, you will analyze CMS compliance reviews, perform audits, monitor performance, and recommend corrective actions to ensure accurate, efficient PBM services,

Qualifications

• Bachelor’s degree in healthcare administration, Pharmacy, or related field.
• 3+ years of operational experience in a retail or hospital pharmacy, PBM, managed care, or related healthcare organization
• Knowledge of CMS Part D regulations, Medicare Advantage requirements, and audit methodologies
• Working understanding of PBM operations, pharmacy claims adjudication, prior authorization processes, formulary administration, and member service operations.
• Proficient computer skills: HPMS, Smartsheet, Sharepoint, Microsoft Office, and database software.
• Demonstrated ability to apply knowledge to recognize problems and identify research needs.

Responsibilities

• Monitor pharmacy operations performance and compliance across Prominence Health and PBM partner.
• Conduct audits and root cause analyses to identify issues and drive improvements.
• Collaborate with Pharmacy, Operations, Health Services, Compliance, Customer Service, and PBM teams.
• Identify risks, service gaps, and process inefficiencies affecting members, providers, and brokers.
• Recommend sustainable corrective actions and support CMS and contractual requirements.

Skills

CMS compliance

Data analysis

Auditing

Pharmacy operations

PBM operations

Communication

Problem solving

Education

Bachelor’s degree in healthcare administration

Pharmacy degree or licensure preferred

Tools

HPMS

Smartsheet

SharePoint

Microsoft Office

Database software

Job description

Prominence Health, part of Universal Health Services, seeks a Pharmacy Quality Analyst to monitor and improve pharmacy operations across Prominence Health and its PBM partner. This role identifies compliance risks, service gaps, and process inefficiencies affecting members, providers, pharmacies, and brokers.

Under the VP Health Services, you will analyze CMS compliance reviews, perform audits, monitor performance, and recommend corrective actions to ensure accurate, efficient PBM services,