MCO Quality Assurance Specialist
4 weeks ago
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.
- Minimum one year CorVel pharmacy benefit management experience.
- Pharmacy Specialist III certification.
- Certified Pharmacy Technician.
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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