Job Description
**Quality Review & Audit Senior Advisor**
**Position Summary:**
The **Quality Review & Senior Audit Advisor** provides enterprise-level quality assurance leadership with a strong focus on **clinical accuracy, pharmacy benefit integrity, and regulatory compliance** . This role applies advanced clinical and pharmacy expertise to validate benefit configurations, evaluate clinical program performance, and ensure alignment with **CMS, NCQA, and state regulatory requirements** across processes, systems, and training programs.
Serving as a **clinical and pharmacy subject matter expert** , the Senior Advisor partners with internal and external stakeholders—including Sales & Account Management, Technology, Configuration, Clinical Operations, Pharmacy, and Data Analytics—to resolve complex clinical and benefit-related issues that impact **patient safety, access to care, regulatory compliance, and client outcomes** . The role drives continuous improvement through...
**Position Summary:**
The **Quality Review & Senior Audit Advisor** provides enterprise-level quality assurance leadership with a strong focus on **clinical accuracy, pharmacy benefit integrity, and regulatory compliance** . This role applies advanced clinical and pharmacy expertise to validate benefit configurations, evaluate clinical program performance, and ensure alignment with **CMS, NCQA, and state regulatory requirements** across processes, systems, and training programs.
Serving as a **clinical and pharmacy subject matter expert** , the Senior Advisor partners with internal and external stakeholders—including Sales & Account Management, Technology, Configuration, Clinical Operations, Pharmacy, and Data Analytics—to resolve complex clinical and benefit-related issues that impact **patient safety, access to care, regulatory compliance, and client outcomes** . The role drives continuous improvement through...