MCO Quality Assurance Specialist

4 weeks ago


Cincinnati, Ohio, United States CorVel Corporation Full time
Job Title: MCO Quality Coordinator

CorVel Corporation is seeking a highly skilled MCO Quality Coordinator to join our team. As a key member of our Pharmacy Solutions team, you will play a critical role in ensuring the consistent delivery of our total workers' compensation solution.

Key Responsibilities:
  • Conduct quality reviews/audits to ensure appropriate management of claims and offices, score office performance, and make suggestions for improvement.
  • Identify and participate in training and developmental needs of claims staff, including training/re-training on existing best practices and new procedures.
  • Provide back-up support for incoming Pharmacy team calls and complete daily rejection report lines.
  • Quality Assurance—gather and handle forwarded daily QA emails.
  • Assist in the training of new representatives and maintain and update reference materials, including Standard Operating Procedures.
  • Provide coaching to all representatives and track monthly quality assurance for individuals.
  • Create quality assurance monthly and yearly reports for management and comprehensive standard operating procedures for Pharmacy team use.
  • Develop and implement new-hire and ongoing professional development training documents and testing for the Pharmacy team.
  • Phone Monitor reps on a rotating basis and provide business-writing training for team members.
  • Publish quarterly department newsletter and complete miscellaneous pharmacy projects as needed.
Requirements:
  • Minimum one year CorVel pharmacy benefit management experience.
  • Pharmacy Specialist III certification.
  • Certified Pharmacy Technician.
About CorVel:

CorVel Corporation is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health, and disability management industries. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities.

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.



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