Quality Analyst III

MedImpact Healthcare Systems, Inc.•San Diego, CA

1d•$71,614 - $119,953•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! MedImpact delivers leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! This position serves as a recognized Subject Matter Expert (SME) in Quality Management for Fee-for-Service and Medicaid programs. It provides strategic guidance, quality governance, consultation, and oversight to cross-functional teams. The role leads complex quality initiatives, drives process improvement, ensures compliance with contractual and regulatory requirements, and influences organizational decisions impacting quality outcomes. The position operates with a high degree of autonomy and is relied upon as a key resource for expertise, problem resolution, and quality best practices.

Requirements

BS/BA and 5+ years’ experience or equivalent combination of education and experience, and 2 years' of SME in respective areas
Intermediate to advanced skills in Microsoft Office with an emphasis on Word, Excel, MS Access and Project.
Intermediate to advanced skills in SQL queries.
Knowledge of Quality Assurance methodologies and practical application.
Ability to research, assess, audit, and apply information to practices and standards.
Strong analytical and problem solving ability and in depth understanding of PBM regulations and CMS guidance.
Demonstrated ability to work in a fast paced environment, learn quickly, appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Demonstrate ability to meet or exceed the competencies as listed.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy
Regularly required to sit and talk or hear.
Regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms.
Occasionally lift and/or move up to 25 pounds.
Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects.
Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

Nice To Haves

Healthcare, Managed Care, Government Programs, Fee-for-Service, or PBM Quality experience is preferred

Responsibilities

Serve as the designated subject matter expert for Quality Management practices across Medicaid and Fee-for-Service programs.
Establish and maintain enterprise quality standards, methodologies, and governance frameworks.
Evaluate emerging regulatory requirements and recommend changes to quality programs, processes, and controls.
Document Quality Management processes, Standard Operating Procedures (SOPs), and workflow documentation to support operational consistency.
Establish standardized quality processes across multiple state implementations.
Provide expert consultation and guidance to operational, implementation, technology, and client-facing teams on quality-related matters.
Act as the escalation point for complex quality issues, compliance findings, and process deficiencies.
Influence cross-functional stakeholders and leadership in quality-related decision making.
Lead complex Root Cause Analysis (RCA) investigations involving operational, system, and process failures.
Identify trends and systemic risks through analysis of quality metrics and recommend enterprise-level corrective actions.
Champion continuous improvement initiatives to enhance quality outcomes, efficiency, and regulatory compliance.
Oversee quality management activities across multiple Medicaid implementations and operational programs.
Review and validate quality deliverables, reports, audits, and corrective action plans developed by other analysts.
Lead quality readiness assessments for new implementations, major enhancements, and regulatory changes.
Develop training materials and facilitate quality education sessions for business and operational teams.
Serve as a recognized internal resource for quality management best practices.
This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.