Pharmacy Quality Analyst (Open to hiring at Sr level)

Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Job Description

Use your strengths at Wellmark as a Pharmacy Quality Analyst!   

In this newly created role, you will serve as a quality assurance partner within the Pharmacy team, driving excellence across PBM and internal pharmacy operations. You will conduct complex quality reviews to ensure accuracy, consistency, and compliance with established standards, while championing enterprise-wide continuous improvement initiatives. Acting as a trusted liaison between internal stakeholders and the PBM, you will lead root cause analyses and leverage reporting and analytics to enable data-driven decision-making. Recognized as a subject matter expert and coach, you will provide consultative guidance and support to cross-functional projects aimed at optimizing pharmacy operations, reducing risk and enhancing member experience. 

Success in this critical role requires a unique blend of skills and experience. The ability to work independently is essential, as you will often navigate complex quality reviews and data with minimal oversight. Proactiveness and strong time management skills are key. Critical thinking is essential in this position, enabling the identification of trends and development of actionable solutions that drive operational improvements. Strong relationship management and collaboration skills are key for partnering effectively with internal teams and PBM stakeholders, ensuring alignment and shared goals. Clear and concise communication, both written and verbal, is vital for translating technical findings into meaningful insights. In addition, curiosity and an inquisitive mindset fuel continuous learning and innovation within our pharmacy department to ensure we are making health care better for our members year-over-year. 

Qualifications

To be considered for Pharmacy Quality Analyst:

Required Qualifications - Must have:

• Associate degree or direct and applicable work experience.
• Minimum of 2 years of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, customer service or similar environment. Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, step therapy).
• Experience with systems analysis or testing to include writing and executing test cases.
• Knowledge of drug coding and concepts (e.g. NDC, GPI, J codes, MediSpan, etc.).
• Ability to perform, document, and or guide others through a series of related steps and takes action to improve existing conditions and processes
• Ability to identify issues or inconsistencies; obtains relevant information, relates and compares data from different sources and identifies alternative solutions
• Knowledge of applicable regulatory standards
• Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
• Demonstrated strong written and verbal communications skills with the ability to clearly and concisely communicate complex concepts with internal and external stakeholders.
• Strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas. Viewed as a subject matter expert and go-to resource.
• Strong collaboration skills, with the flexibility to adapt to different stakeholders
• Proficiency with Microsoft Office, including Excel; use of pivot tables, charts, and formulas is preferred. Technical aptitude to learn new software quickly.
• Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment. Flexible and adaptable to change.

Preferred Qualifications - Great to have:

• Bachelor's degree.
• Certified Pharmacy Technician.

To be considered for Sr Pharmacy Quality Analyst:

Required Qualifications - Must have:

• Bachelor’s degree or equivalent applicable experience.
• 3+ years of pharmacy operations experience in managed care, PBM, or health care settings.
• Demonstrated experience in quality assurance, data analysis, and process improvement.
• Strong knowledge of pharmacy practice (e.g., drug coding, formulary, prior authorization, step therapy).
• Experience leading root cause analysis and implementing strategic improvements.
• Advanced proficiency in Microsoft Excel (pivot tables, charts, formulas) and reporting tools.
• Strong written and verbal communication skills, with the ability to present complex information to leadership.
• Experience mentoring or coaching others.
• Understanding of NCQA standards, CMS regulations, and internal compliance protocols.
• Demonstrates strategic judgment in balancing competing deadlines, proactively mitigating risks, and ensuring timely delivery of high-impact work.

Preferred Qualifications - Great to have:

• Certified Pharmacy Technician.
• Experience with PBM coding and configuration.
• Prior experience leading cross-functional projects or enterprise initiative.

Additional Information

What you will do:

a. Lead assigned quality reviews of complex PBM configurations and internal pharmacy operations, ensuring alignment with Wellmark standards and regulatory requirements (e.g., validating coding accuracy across formulary, benefits, network, and prior authorization setups).

b. Conduct root cause analysis of quality issues and recommend actionable improvements. Collaborate with internal teams to implement enhancements that improve operational efficiency and member outcomes.

c. Collaborate with internal stakeholders and/or vendor subject matter experts on quality issues identified, ensuring timely remediation and documentation.

d. Develop and maintain reporting utilizing Excel and potentially PowerBI to monitor quality trends and performance metrics. Analyze data to identify risks, opportunities, and the impact of quality initiatives. Present findings to leadership.

e. Provide guidance and training to team members and stakeholders on pharmacy quality standards and processes. Represent the pharmacy team in enterprise-wide quality and compliance initiatives. 

f. Provide back-up assistance in cross-functional projects and testing efforts related to benefit design and system enhancements. Support the development of test plans and documentation for unique or complex configurations. 

g. Assist in the development and delivery of communications related to quality findings and PBM updates. Ensure messaging is clear, accurate, and aligned with Wellmark's customer experience principles. 

h. Maintain accurate records of quality reviews, coding validations, and issue resolutions. Ensure adherence to NCQA, CMS and internal compliance standards. 

i. Other duties as assigned. 

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants 

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