Quality Senior Specialist / Delegation Quality Manager
St. Louis, Missouri, United States Of America
Job ID: REQ20023268
The Quality Senior Specialist/Delegation Quality Manager position is a new and exciting role developed to provide our clients with the quality oversight documentation and other quality and accreditation materials required in support of client accreditation needs in a thorough and timely manner. This position works collaboratively with the overall Quality Programs & Accreditation team, as well as the Client Audit Department, Client Account Management, and other business partners across the enterprise to ensure that quality and accreditation related evidence is accurately provided as outlined by client request and/or client audit parameters, when Express Scripts and/or subsidiaries are performing functions or services on behalf of a client. The position will also support and complete delegation oversight activities and audits associated with specialty pharmaceutical manufacturer pharmacy quality audits and specialty payer credentialing requests.This position can be located at any Express Scripts or Cigna office in the USA or in a Work At Home environment.
- Communicate requirements and collaborate with the quality and accreditation team and matrix areas to ensure that the national quality program activities are in place that adhere to the clients’ delegation arrangements when Express Scripts performs functions on behalf of a client.
- Collect and present quality and accreditation evidence in support of a quality oversight audit of Express Scripts and/or subsidiaries. Collaborate with the quality and accreditation team and business partners to ensure any corrective action plans requested during an audit or annual oversight process are provided timely with appropriate follow up to validate closure of the open items.
- Support creation of any quality required reporting to be submitted timely and in accordance with contractual requirements. Follow up, as necessary, on any question(s) raised in response to the reports.
- Provide clients with annual program documents, e.g., program descriptions, annual work plans and evaluations, as well as policies & procedures that may be required in accordance with contractual requirements.
- Evaluate activities necessary to proactively prepare for an audit, which may include a mock audit or gathering of evidence, to ensure the required information is readily available. Communicate results to the accreditation team and appropriate matrix areas and manage any internal corrective action plans to ensure closure of identified opportunities. Communicate results of the external and/or internal oversight activities to the appropriate quality committee or matrix areas, as needed.
- Collaborate with Account Management team, Client Audit team and other Express Scripts and subsidiaries business partners to coordinate and schedule delegation audits or other monitoring activities that meet accreditation and delegation agreement requirements.
- Effectively analyze, compile, and communicate audit findings, including risks and opportunities. Coordinate and follow-up on Corrective Action Plans, as needed.
- Additional quality or accreditation activities, such as gathering evidence and road maps for an accreditation survey specific to the delegated activities.
- Participate on internal team meetings, quality committee meetings, and/or delegate meetings, as needed, to support communication of results for those activities related to arrangements in which Express Scripts performs functions or services on behalf of a client “Express Scripts As Delegate”.
- Other accreditation projects as assigned.
- Bachelor’s degree in related field or 14 to 18 years of experience
- 8-12 years relevant experience with Bachelor’s Degree or Master’s degree and 6-10 years of relevant experience
- Previous quality experience and/or active participation in either presenting evidence for an accreditation (e.g. URAC, NCQA, VIPPS, AAAHC, TJC), state or federal regulatory audits, or a client/consultant audit
- Previous experience (2-3 years) in at least one of the pharmacy programs noted in the summary, gaining a solid understanding of healthcare program delivery
- Demonstrated comfort with and strong ability to effectively communicate through verbal and written channels, with various levels of internal and external audiences
- Strong analytical and collaborative problem solving skills
- Ability to work cross-functionally, proactively communicate and manage projects
- Excellent PC skills including Microsoft Office.
- Registered Nurse or Registered Pharmacist with active license and no restrictions or other appropriate clinical certification
- Previous experience in audit and/or client account management
- Previous experience in multiple programs noted in the summary
- Demonstrated ability to effectively manage multiple projects; effective time management skills
- Demonstrated ability to manage in a highly matrixed environment
- Demonstrated ability to learn and work independently in a fast paced environment
- Demonstrated ability to influence change
ABOUT THE DEPARTMENT
The Legal department is ultimately tasked with protecting the Express Scripts brand. Our teams of attorneys and legal professionals oversee contracting activities and licensing, ensure corporate and SEC compliance, and support merger and acquisition activity. Legal also drives the company’s public affairs efforts at the
ABOUT EXPRESS SCRIPTS
Advance your career with the company that makes it easier for people to choose better health.
Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the “Most Admired Companies” in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.
Express Scripts is an equal opportunity employer/disability/veteran