Job Description

The Pharmacy Quality Manager manages the clinical and operational aspects of improving quality of care for Steward Health Choice health plan members.  Responsibilities include:  developing and maintaining policies and processes for the pharmacy quality department that are compliant with all relevant laws, regulations, accreditation requirement and contracts; working collaboratively with the other members of the pharmacy department, health plan leadership, the Pharmacy Benefit Management (PBM) and other vendors on developing, implementing, and managing quality based programs, measuring performance of programs and staff to achieve favorable quality measurement outcomes; developing and managing the pharmacy quality team who conducts member or provider outreach which includes assessing staff performance and auditing of work product to ensure quality and productivity standards are met.  The Pharmacy Quality Manager works closely with the National Director of Pharmacy, health plan pharmacists, technicians, medical, quality, and Steward Healthcare leadership teams to develop, implement, and refine strategies for innovative and cost-effective clinical programs which will improve health plan performance in metrics defined by regulator contracts, accreditation standards, and organization goals.

 

Manage pharmacy quality department (specifically people, process, and technology) efficiently and effectively and serve as key point person for quality measure status, system functionality, and staff operations.  Educate Steward Health Choice department leadership and supporting staff on performance requirements and metrics and future projections.  Create and present quality metric reporting to the leadership team informing data driven decisions.  Train and motivate staff to address quality related gaps in care.  Monitor productivity and quality; appropriately escalate concerns to management in a timely manner.  Manage and interpret data and quality measure technical specifications to meet or exceed accreditations and government regulatory (CMS, Medicaid, Medicare, etc.) standards of excellent for all lines of business.  Perform other position appropriate duties as required in a competent, professional, and courteous manner.

 

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



Qualifications

Qualifications:

Bachelor's degree in a health care or related field

At least 5 (five) years of experience working with HEDIS and Medicare STARS technical specifications and data analysis

Two (2) years of experience managing pharmacy staff

Proficient in the principles and practices of managed care pharmacy

Proficient in application development and database support

Proficient in SQL Server, MS Access, and Tableau

 

Application Instructions

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