Department: Pharmacy - Quality
Reports to: Manager Quality and Audit
Location: 4110 George Road Tampa FL 33634
Performs complex and detailed quality audits to assess compliance with WellCare's contractual and regulatory requirements.
- Conducts quality reviews on audits performed by the team.
- Researches and performs root cause analysis and communicates the process improvement opportunity options.
- Prepares ad hoc reports to summarize audit findings.
- Facilitates meetings representing the Quality and Audit Team with internal and external business partners as needed.
- Tracks and maintains quality results for appropriate distribution.
- Acts as a subject matter expert for all audit questions and issues.
- Acts as a mentor for the Quality auditors. Provides real-time feedback as appropriate for the job function.
- May participate in training activities for new and establish team members as well as in special projects and in other duties as assigned.
- Performs other duties as assigned.
- Coordinates and participates in the Enrollment data file extraction process (e.g: gathering of criteria, review and testing of data).
- Required A High School or GED
- Preferred A Bachelor's Degree in a related field
- Required 4 years of experience in Internal: a healthcare organization; preferably in Enrollment / Customer Service / CTM / Grievance processes.
- Required 5 years of experience in External: a healthcare organization; preferably in Enrollment / Customer Service / CTM / Grievance processes.
Licenses and Certifications:
- Intermediate Ability to multi-task
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Other Ability to remain calm under pressure
- Intermediate Other Uses tact and diplomacy when performing job duties.
- Intermediate Other Ability to perform detailed review, research and analysis to ensure Operational accuracy across multitude of systems.
A license in one of the following is required:
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft PowerPoint