Job Description

Supervisor(a) de Calidad en Farmacia

Regular


Exempt

GENERAL DESCRIPTION:

Responsible for overseeing the quality assurance, performance monitoring, and training functions of pharmacy utilization management within the unit. Ensures that operational processes meet established standards, regulatory requirements, and organizational goals. Designs and implements monitoring tools, conducts audits, and analyzes performance data to identify trends and opportunities for improvement. Oversees the development and delivery of training programs to enhance staff competencies, ensure consistency in clinical decision-making, and promote compliance with internal policies and external regulations.

ESSENTIAL FUNCTIONS:

Develop and maintain quality monitoring programs to ensure that clinical and operational processes meet internal standards and regulatory requirements. In collaboration with management, create corrective and preventive actions to mitigate risks, ensuring the ongoing success of implemented solutions, and maintaining regulatory compliance for the company's two lines of business (LOB). Analyzes performance data and quality metrics while conducting audits of clinical reviews and documentation to generate actionable reports that identify trends, gaps, and areas for improvement, supporting effective decision-making and strategic planning. Investigates and resolves escalated issues related to clinical reviews, documentation quality, or staff performance, ensuring timely and appropriate action. Prepares documentation and supports internal and external audits, ensuring readiness and compliance with all applicable standards. Ensures all communications, marketing materials, and digital content created by the organization comply with current regulatory guidelines, contractual obligations, and internal policies and procedures. Implements and supervises initiatives related to medications under utilization management, ensuring alignment with operational goals and drug trend management while assessing their impact on workflow efficiency, clinical suitability, and cost containment, all aimed at optimizing workflows to enhance member and provider experiences. Identifies and communicates findings or opportunities for improvement to the Formulary Teams, providing data-driven recommendations to support formulary optimization and policy development. Generate and evaluate operational metrics, reports, and dashboards to assess performance in terms of volume, speed, quality, productivity, operational impact, and other requested metrics and reports. Handles sensitive situations presented by clients with other departments and responds to internal inquiries received from other departments. Ensures training materials are up-to-date, accurate, and compliant with regulatory requirements and internal policies, while coordinating refresher training sessions and targeted learning initiatives that address performance trends, audit findings, or operational needs. Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company. Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.

MINIMUM QUALIFICATIONS:

Education and Experience:

Bachelor's Degree in areas related to Natural Sciences and/or Business Administration. At least four (4) years of experience working in a Pharmacy Call Center, or participating in clinical evaluation processes, pharmacotherapeutic monitoring, or activities related to medication review, preferably in the Healthcare Industry. At least one (1) year of experience supervising personnel.

OR

Education and Experience:

Associate's Degree in Pharmacy Technician. At least five (5) years of experience working in a Pharmacy Call Center, or participating in clinical evaluation processes, pharmacotherapeutic monitoring, or activities related to medication review, preferably in the Healthcare Industry. At least one (1) year of experience supervising personnel.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses:

For an Associate's Degree, a valid Pharmacy Technician license and registration is required.

Other:

N/A

Languages:

Spanish - Intermediate (comprehensive, writing and verbal)

English - Intermediate (comprehensive, writing and verbal)

"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Accion Afirmativa para reclutar a Mujeres, Minorias, Veteranos Protegidos y Personas con Impedimento

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