Pharmacy Education

Regular Exempt GENERAL DESCRIPTION: Responsible for leading the strategy, governance, execution, and continuous optimization of Pharmacy Stars, quality, educational, and performance management initiatives that support organizational objectives and Medicare Star Ratings performance. Manage the evaluation of quality and operational performance, identify strategic opportunities and risks, and drive cross-functional initiatives that improve pharmacy outcomes, member experience, regulatory compliance, operational effectiveness, and overall organizational performance. Serves as a key business partner in aligning quality improvement efforts with corporate goals, regulatory requirements, and long-term growth strategies. ESSENTIAL FUNCTIONS:
• Manage the assessment and interpretation of Pharmacy Stars, Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), Acumen, operational, and quality performance data to identify performance gaps, emerging trends, strategic risks, and improvement opportunities, and direct the development of action plans to achieve organizational targets.
• Provide strategic oversight for the development, validation, maintenance, and reporting of Pharmacy Stars dashboards, scorecards, forecasts, simulations, performance reports, and executive-level analyses that support informed decision-making and organizational performance management.
• Monitor regulatory, industry, and quality performance trends, evaluate business and operational impacts, and lead the implementation of strategic initiatives and process improvements that strengthen organizational readiness, compliance, and performance outcomes.
• Ensure compliance with the Medicare and Medicaid Service Centers (CMS), Medicare Advantage (MA), Puerto Rico Health Insurance Administration (ASES), and organizational requirements through the oversight of educational materials, web content, provider communications, regulatory reporting, policy updates, and operational documentation, while proactively identifying and mitigating compliance risks.
• Manage the development, implementation, and ongoing enhancement of departmental policies, procedures, operational frameworks, educational strategies, and performance management processes that promote quality excellence, regulatory compliance, and operational effectiveness.
• Partner with internal business leaders, operational areas, and external vendors to develop and execute strategic and operational initiatives that support organizational priorities and quality performance objectives.
• Oversee the design, execution, and evaluation of educational and engagement strategies aimed at improving medication adherence, patient safety, Combined Use of Opioids and Benzodiazepines (COB), medication therapy management outcomes, quality measures, and overall member health outcomes.
• Lead provider, pharmacy, member, and vendor engagement initiatives, including educational campaigns and quality improvement interventions designed to close care gaps, enhance stakeholder collaboration, and improve performance results.
• Manage departmental educational operations, ensuring effective governance, prioritization, coordination, and execution of projects, communication strategies, approval workflows, website and portal publications, educational events, training activities, and pharmacy-related professional programs.
• Provide oversight for the development, review, approval, and deployment of educational materials, communications, and outreach initiatives to ensure strategic alignment, regulatory compliance, message consistency, and achievement of business objectives.
• 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.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM

QUALIFICATIONS:
Education and

Experience:
Bachelor’s Degree in Business Administration, Public Health Major in Health Services Management, or related fields. At least five (5) years of experience in pharmacy operations, managing quality initiatives, educational programs, performance reporting, and analyzing healthcare and performance data to identify trends, opportunities, and corrective actions in the Healthcare Industry. At least two (2) years of experience supervising personnel. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: Not required. Other: Knowledge of Medicare Stars Rating Program requirements is preferred. Languages: Spanish – Advanced (comprehensive, writing and verbal) English – Advanced (comprehensive, writing and verbal) “We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”