Quality Review and Audit Lead Analyst - Express Scripts - Remote

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Written by AI from the job title and company, not by Express Scripts by Evernorth, so some details may not match this job. The employer's own page has the real description.

Job Overview

The Quality Review and Audit Lead Analyst at Express Scripts by Evernorth plays a pivotal role in ensuring the integrity and efficiency of audit processes pertaining to quality reviews. This position is responsible for analyzing and evaluating operational practices and service delivery, thereby enabling the organization to uphold its commitment to excellence. The Lead Analyst will guide audit assessments, recommend enhancements based on findings, and collaborate with cross-functional teams to establish best practices, driving continuous improvement across operations.

Job Responsibilities

• Conduct comprehensive quality reviews and audits of operational procedures and outcomes to ensure compliance with standard operating procedures.
• Develop and maintain audit plans, including schedules, scopes, and methodologies, ensuring alignment with regulatory and business requirements.
• Collaborate with various departments to analyze audit findings and recommend actionable solutions for performance enhancement.
• Prepare detailed audit reports and presentations to communicate results to executive management and other stakeholders.
• Lead training sessions about quality standards and audit processes to enhance team capabilities and foster a quality-driven culture.
• Monitor and evaluate the effectiveness of action plans implemented in response to audit findings.
• Stay updated on industry trends, compliance regulations, and best practices in quality assurance and audit methodologies.

Qualifications

• Bachelor's degree in a related field such as Business Administration, Healthcare Management, or a related discipline.
• A minimum of 5 years of experience in quality assurance or auditing within the healthcare or pharmacy benefit management sectors.
• Strong familiarity with regulatory requirements, compliance processes, and quality assurance frameworks.
• Proficiency in auditing techniques and tools, as well as data analysis methods.
• Exceptional communication skills, both written and verbal, with an ability to present data findings clearly to various stakeholders.
• Master's degree or professional certification in quality or auditing (e.g., Certified Quality Auditor, Six Sigma) is a plus.

Technologies & Tools

This role utilizes a variety of technologies and tools to facilitate quality reviews and audits. The preferred technologies include data analytics software, audit management systems, and electronic health record (EHR) platforms. Familiarity with Microsoft Office Suite, especially Excel for data analysis and reporting, is essential. Experience with Business Intelligence tools like Tableau or Power BI may also be beneficial in analyzing audit results effectively.

Ideal Candidates

Ideal candidates for the Quality Review and Audit Lead Analyst position possess a strong analytical mindset and meticulous attention to detail. They are proactive problem-solvers who thrive in collaborative environments and are committed to fostering a culture of quality and excellence. Strong leadership skills, coupled with the ability to engage with diverse teams, are essential, as well as the capability to adapt to changing regulatory landscapes and continuous improvement initiatives. Candidates should demonstrate a passion for quality enhancement and a dedication to operational excellence.