• Responsible for developing, defining, maintaining and instituting a prior authorization quality assurance program for the Pharmacy Technician and Pharmacist clinical review function • Responsible for summarizing quality assurance activities and presenting to leadership and the Clinical Review Team • Responsible for developing, maintaining and conducting an interrater reliability program • Monitors clinical appeals to further enhance the prior authorization program • Collaborate with Pharmacists within the Pharmacy and Therapeutics Committee and Criteria Review Committee process and participate in development of clinical criteria for medications requiring prior authorization • Identifies opportunities for technology enhancements, process improvement or coaching for team members • Collaborate with Clinical Review Business Analyst to support system enhancements • Support Policy and Procedure development and maintenance • Become a subject matter expert on department standards and processes

Our client is a rapidly growing, automation-led service provider specializing in IT, business process outsourcing (BPO), and consulting services. With a strong focus on digital transformation, cloud solutions, and AI-driven automation, they help businesses optimize operations and enhance customer experiences. Backed by a global workforce of over 32,000 employees, our client fosters a culture of innovation, collaboration, and continuous learning, making it an exciting environment for professionals looking to advance their careers. Committed to excellence, our client serves 31 Fortune 500 companies across industries such as financial services, healthcare, and manufacturing. Their approach is driven by the Automate Everything, Cloudify Everything, and Transform Customer Experiences strategy, ensuring they stay ahead in an evolving digital landscape. As a company that values growth and professional development, our client offers global career opportunities, a dynamic work environment, and exposure to high-impact projects. With 54 offices worldwide and a presence in 39 delivery centers across 28 countries, employees benefit from an international network of expertise and innovation. Their commitment to a 'customer success, first and always' philosophy ensures a rewarding and forward-thinking workplace for driven professionals. We are currently searching for a Test Manual Lead: Responsibilities - Lead and coordinate manual testing activities for multiple projects, ensuring quality and reliability of deliverables. - Design, develop, and execute functional test plans including smoke, regression, and sanity testing. - Conduct API testing using tools such as Postman to validate integration points and data flows. - Validate data accuracy and consistency using SQL queries and database verification techniques. - Collaborate with cross-functional teams in Agile environments to ensure alignment with project goals and timely defect resolution. - Apply SDLC and STLC principles to maintain structured testing processes and standards. - Provide mentorship and guidance to junior QA team members, promoting knowledge sharing and continuous improvement. Requirements - 6+ years of experience in manual testing with proven leadership capabilities. - Strong proficiency in functional testing methodologies: smoke, regression, sanity. - Hands-on experience with API testing tools such as Postman. - Good understanding of SQL queries for data validation and verification. - Solid knowledge of SDLC and STLC processes. - Excellent analytical and problem-solving skills with attention to detail. - Effective communication and collaboration skills to work with technical and non-technical stakeholders. Desired - Experience with automation testing tools such as RSAT or EasyRepro. - Prior experience in Agile/Scrum projects. Languages - Advanced Oral English. - Native Spanish. Note: - Fully remote If you meet these qualifications and are pursuing new challenges, start your application on our website to join an award-winning employer. Explore all our job openings | Sequoia Career’s Page: https://www.sequoia-connect.com/careers/ Requirements - 6+ years of experience in manual testing with proven leadership capabilities. - Strong proficiency in functional testing methodologies: smoke, regression, sanity. - Hands-on experience with API testing tools such as Postman. - Good understanding of SQL queries for data validation and verification. - Solid knowledge of SDLC and STLC processes. - Excellent analytical and problem-solving skills with attention to detail. - Effective communication and collaboration skills to work with technical and non-technical stakeholders.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. REMOTE OPPORTUNITY! Centene is seeking a Quality Improvement Abstractor to support quality initiatives through accurate data abstraction, review, and validation of clinical data. The ideal candidate will have experience with HEDIS, quality measure abstraction, and overreads, ensuring accuracy, compliance, and consistency with established guidelines. Requirements: - Experience with HEDIS, quality measure abstraction, and overreads - Familiarity with healthcare quality improvement processes, metrics, and documentation standards - RN or LPN license preferred (not required) - Strong attention to detail and ability to interpret clinical records accurately - Ability to work Monday–Friday, 8:00 AM–5:00 PM EST - Must reside in the Eastern (EST) or Central (CST) Time Zone This role is ideal for detail-oriented professionals with a strong understanding of quality measures and experience ensuring data accuracy through abstraction and overread processes. Position Purpose: Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements. - Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards. - Review medical records and abstract data for HEDIS and other measure sets in compliance with standards. - Track and report on issues and outcomes related to abstractions and over-reads - Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required - Perform other quality initiatives as necessary - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Associate’s degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred. Licenses/Certifications: Current state’s RN or LPN license preferred. Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Role Description We are looking for a skilled individual to join our rapidly growing team at Bluelight. This position is ideal for someone who thrives in a fast-paced, dynamic environment where everyone's opinions and efforts are valued and appreciated. You will have the opportunity to contribute to challenging and meaningful projects, developing high-quality applications that stand out in the market. We value continuous learning, personal growth, and hard work, offering a collaborative environment that promotes professional development. If you are passionate about software development and eager to be part of a growing software consultancy, we invite you to apply and join us on this exciting journey. Qualifications - 3+ years of experience in testing Web Products. - Solid knowledge and working experience with testing tools. - Development of test plans: the creation of test cases and debugging. - Additional knowledge in Web technologies. - Ability to take extreme ownership over your work. - Ability to identify with Bluelight's clients' goals. - A positive mindset and a can-do attitude. - Forensic attention to detail. Benefits - Competitive salary and bonuses, including performance-based salary increases. - Generous paid-time-off policy. - Flexible working hours. - Work remotely. - Continuing education, training, conferences. - Company-sponsored coursework, exams, and certifications.