Call Monitoring Quality Analyst – Healthcare / Specialty Pharmacy

POSITION: Call Monitoring Quality Analyst – Healthcare / Specialty Pharmacy

Who We Are

OptiMed Health Partners optimizes health outcomes and quality of life through personalized and coordinated care. We have been serving patients for over 30 years with a focus on high-quality care in retail pharmacy, specialty pharmacy, and infusion services. The OptiMed Vision reimagines healthcare solutions to achieve unsurpassed value. Our results-oriented culture fosters learning, providing growth opportunities for our employees and exceptional care for our patients in all 50 states.

The Impact of This Role

The Call Monitoring Quality Analyst plays a critical role in ensuring high-quality, compliant, and patient-centered service across OptiMed’s healthcare and specialty pharmacy operations. By monitoring patient, provider, and payer interactions, this role helps safeguard patient safety, confidentiality, and satisfaction while supporting regulatory compliance. Insights and feedback provided by this role directly influence care quality, staff performance, operational outcomes, and continuous improvement across Patient Services and Pharmacy Operations.

What You’ll Be Doing

• Monitor, evaluate, and score inbound and outbound patient, provider, and payer calls and digital interactions using established healthcare quality standards
• Ensure adherence to HIPAA, CMS guidelines, state pharmacy regulations, and internal standard operating procedures
• Assess compliance with call scripting, verification processes, documentation accuracy, and confidentiality requirements
• Provide timely, constructive, and actionable feedback to patient care coordinators, pharmacy technicians, and call center staff
• Identify quality trends, compliance risks, and opportunities to improve patient experience, safety, and operational outcomes
• Collaborate with training, compliance, and pharmacy leadership to recommend coaching plans, corrective actions, and process improvements
• Participate in calibration sessions to maintain consistent and objective quality scoring
• Prepare quality reports, dashboards, and compliance metrics for leadership review
• Support internal and external audits, accreditation efforts (URAC, ACHC, as applicable), and regulatory reviews
• Escalate quality or compliance concerns related to patient safety, medication handling, or documentation accuracy

Who You’ll Be Working With

This role partners closely with Patient Services, Pharmacy Operations, Training, Compliance, Quality Assurance, and Leadership teams to support consistent service quality, regulatory readiness, and continuous improvement across the organization.

Skills and Experience You’ll Bring to the Table

• High school diploma or GED required; associate’s or bachelor’s degree in healthcare administration, quality, or a related field preferred
• 2+ years of experience in a healthcare contact center, specialty pharmacy, or regulated medical environment
• Prior experience in quality assurance, call monitoring, or compliance review preferred
• Strong working knowledge of HIPAA privacy and security requirements
• Proficiency with call monitoring tools, quality management systems, CRM platforms, and Microsoft Office (Excel, Word)
• Experience preparing quality reports, audits, or compliance documentation
• Familiarity with specialty pharmacy, pharmacy benefit management (PBM), or patient access services preferred
• Knowledge of healthcare quality metrics and KPIs, including QA scores, CSAT, compliance rates, and first-call resolution
• Understanding of accreditation and regulatory frameworks such as URAC, ACHC, or CMS preferred

Competencies You’ll Bring to the Table

• Patient-first mindset with a strong focus on safety, privacy, and confidentiality
• Excellent attention to detail and documentation accuracy
• Strong verbal and written communication skills, including the ability to deliver sensitive feedback professionally
• Sound judgment when identifying regulatory, compliance, or patient safety risks
• Ability to work independently while collaborating cross functionally
• Analytical and problem-solving capabilities
• Continuous improvement mindset with a focus on process optimization
• Professional discretion when handling protected health information (PHI)

Work Environment

This role operates in an office, hybrid, or remote healthcare or specialty pharmacy environment. The position requires prolonged listening, sustained screen time, and detailed documentation while adhering to strict confidentiality, security, and data privacy standards.

OptiMed Health Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.