Pharmacy Quality Analyst
UHS
Summary
Under the direction of the VP of Health Services, the Pharmacy Quality Analyst is responsible for monitoring, analyzing, auditing, and improving pharmacy-related operational performance across Prominence Health and its Pharmacy Benefit Manager (PBM) partner.
Job description
This position serves as a key resource for identifying operational breakdowns, compliance risks, service gaps, and process inefficiencies that impact members, providers, pharmacies and brokers.
The Pharmacy Quality Analyst utilizes data analysis, operational audits, CMS compliance reviews, performance monitoring, and root cause methodologies to identify trends, investigate issues, and recommend sustainable corrective actions.
The role supports operational excellence by ensuring pharmacy services, claim processing, prior authorization functions, formulary administration, customer service, and other PBM-related activities are delivered accurately, efficiently, and in compliance with CMS, Medicare Advantage, and contractual requirements.
This position works closely with Pharmacy, Operations, Health Services, Compliance, Customer Service, and PBM partners to support continuous improvement initiatives that enhance regulatory compliance, operational effectiveness, and overall customer experience.
Requirements
- Bachelor's degree in healthcare administration, Pharmacy, Business Administration, Public Health, Compliance, Data Analytics, or related field
- Current and valid state licensure as a pharmacy technician is preferred
- 3 or more 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: Health Plan Management System (HPMS), Smartsheet, Sharepoint, Microsoft Office (Word, Excel, PowerPoint), and database software
- Demonstrated ability to apply knowledge to recognize the existence of problems or potential problems and identify additional research to be undertaken or assistance in the following areas: internal audit standards, procedures and techniques, management principles and deviations from ethical business practices, and fundamentals of business management
- Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare
- Demonstrated ability to design and develop reports, documents and spreadsheets
- Demonstrated ability to communicate verbally and with technical writing in a way that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations
- Decisive and exercises good judgment under pressure
- Demonstrated skills in critical thinking, problem solving, and the analysis, interpretation and evaluation of complex information
- Demonstrated ability to maintain effective collaborative working relationships with staff
- Demonstrated ability to work independently with minimal supervision
- Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff
- Simultaneous action at varying stages—initiation, follow through, and completion—on a number of different projects
- Strict adherence of rules and regulations for confidentiality and compliance
Benefits
- Loan Forgiveness Program
- Competitive Compensation
- Generous Paid Time Off
- Medical, Dental, Vision Plans
- Prescription Drug Plans
- 401(k) with company match
- Discounted stock plan
- SoFi Student Loan Refinancing
- Career development opportunities
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.