Position Summary:
As a Consultant/Quality Analyst, you will be responsible for the integrity of the prior authorization (PA) system used for Medicare Part D Coverage Determinations and Appeals. The Consultant/Quality Analyst will work closely with PA Admin and Medicare Operations to test and validate the utilization management (UM) criteria, decision trees, drug lists, and letters that are loaded and functioning properly in the PA system. The Consultant/Quality Analyst is ultimately responsible for setting up and testing the systems that will be used for the Medicare D Open Enrollment. Ensuring the quality of PA products for business users by testing cases and doing regression testing. As a Consultant/Quality Analyst developing and executing formal test plans to ensure the delivery of quality software and to ensure that all information systems products and services meet minimum organization standards and end-user requirements.
Required Education & Experience:
- 1+ years of experience in the PBM industry
- Strong written and verbal communication skills, including presentation skills
- Proven quality results experience
- 1+ years of experience with Microsoft Office applications including Word, Excel, Access and
- Previous analytical experience
- Team player with the ability to work independently
- Demonstrated ability to manage multiple complex, on- going projects, as well as meet timelines for critical compliance/accreditation deliverables
- 1+ years of previous testing experience
- Good skills for negotiating priorities among multiple high priority business tasks