Quality Review & Audit Senior Advisor

Position Summary:

The Quality Review & Senior Audit Advisor provides enterprise-level quality assurance leadership with a strong focus on clinical accuracy, pharmacy benefit integrity, and regulatory compliance. This role applies advanced clinical and pharmacy expertise to validate benefit configurations, evaluate clinical program performance, and ensure alignment with CMS, NCQA, and state regulatory requirements across processes, systems, and training programs.

Serving as a clinical and pharmacy subject matter expert, the Senior Advisor partners with internal and external stakeholders—including Sales & Account Management, Technology, Configuration, Clinical Operations, Pharmacy, and Data Analytics—to resolve complex clinical and benefit-related issues that impact patient safety, access to care, regulatory compliance, and client outcomes. The role drives continuous improvement th...