Pharmacy Quality Analyst
Responsibilities
Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
About the role
Under the direction of the VP of Health Services, the Pharmacy Quality Analyst is responsible for monitoring, analyzing, auditing, and improving pharmacy-related operational performance across Prominence Health and its Pharmacy Benefit Manager (PBM) partner. This position serves as a key resource for identifying operational breakdowns, compliance risks, service gaps, and process inefficiencies that impact members, providers, pharmacies and brokers. The Pharmacy Quality Analyst utilizes data analysis, operational audits, CMS compliance reviews, performance monitoring, and root cause methodologies to identify trends, investigate issues, and recommend sustainable corrective actions. The role supports operational excellence by ensuring pharmacy services, claim processing, prior authorization functions, formulary administration, customer service, and other PBM-related activities are delivered accurately, efficiently, and in compliance with CMS, Medicare Advantage, and contractual requirements. This position works closely with Pharmacy, Operations, Health Services, Compliance, Customer Service, and PBM partners to support continuous improvement initiatives that enhance regulatory compliance, operational effectiveness, and overall customer experience.