Pharmacy QA Specialist

Job Summary The Pharmacy QA Specialist plays a critical role in the pharmacy review process, supporting PBM clients by ensuring the accuracy, completeness, and quality of pharmacy-related determinations and documentation. This role is responsible for coordinating with clients, pharmacists, and internal teams to ensure that all reviews are completed in accordance with client requirements, regulatory standards, and turnaround time expectations. In addition to standard QA responsibilities, the Pharmacy QA Specialist provides subject matter expertise related to pharmacy benefits, medication reviews, and PBM processes, and serves as a resource for non-pharmacy QA staff on medication-related questions. Dane Street ’s success relies on individual and team contributions every day. We care for our customers, each other, and Dane Street . All employees are expected to maintain a positive working environment that promotes client satisfaction and high-quality outcomes. Major Duties & Responsibilities Client Interaction Provide regular status updates to PBM clients regarding case progress and completion timelines Evaluate the quality and completeness of pharmacy reviews to ensure alignment with client policies, formularies, and regulatory requirements Ensure that determinations are supported by appropriate clinical and/or formulary rationale Clarify ambiguous or incomplete requests with clients Distribute final determinations in accordance with client-specific requirements Manage and execute clarification and addendum requests from clients Follow up with clients for missing or incomplete information necessary to complete reviews Reviewer / Pharmacist Interaction Work directly with pharmacists and/or reviewers to ensure all client questions are addressed accurately Ensure determinations are supported by appropriate clinical guidelines, formulary rules, and PBM policies Conduct follow-ups to ensure timely completion of reviews Provide feedback to pharmacists regarding documentatio