Pharmacy Clinical & Quality Programs AVP

Regular

Exempt

GENERAL DESCRIPTION:

Supports the strategic design, execution, and oversight of all clinical and quality programs within the Pharmacy Department. These programs include Medication Therapy Management (MTM), Drug Management Programs (DMP), Centers for Medicare and Medicaid Services (CMS) STARS initiatives, pharmacy utilization strategies, academic detailing, and the regulatory handling of grievances and appeals. Ensures that the pharmacy’s clinical strategy is fully aligned with regulatory requirements, population health objectives, and broader organizational goals.

Fosters strong cross-functional collaboration, manages external stakeholder relationships, and serves as the enterprise-wide clinical pharmacy subject matter expert.

ESSENTIAL FUNCTIONS:

- Develop and monitor the execution of comprehensive work plans for Clinical Services, Pharmacy Utilization, and Account Management, ensuring compliance with federal and local regulations and applicable standards.
- Support the design, implementation, and continuous improvement of clinical pharmacy programs, aligning them with organizational goals, healthcare quality standards, and member needs.
- Oversee all delegated vendor functions related to (Medication Therapy Management Program) MTMP, Integrated Diabetes Program, Specialty Pharmacy Interventions, Designated Medical/Prescribing Practitioner (DMP/DPP), and STARS measures, ensuring full compliance with regulatory expectations.
- Support the development and execution of comprehensive clinical and quality pharmacy programs in alignment with federal and state regulatory requirements, organizational goals, and best practices in managed care pharmacy.



Ensure that all program components, including those delegated to external vendors, comply with the Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and other applicable regulatory bodies.
- Support the regulatory agencies audits and internal monitoring processes and ensure the processes within the unit are executed in compliance with the regulatory requirements and the approved company policies and procedures.
- Serve as the clinical pharmacy liaison with Clinical Affairs, ensuring seamless integration of pharmacy services with broader clinical initiatives targeting member outcomes and healthcare cost management.
- Represent the pharmacy department in client meetings, regulatory engagements, and internal executive forums. Deliver strategic presentations and serve as the pharmacy clinical lead in external stakeholder discussions across all lines of business.
- Contribute to the development of the departmental budget. Monitor expenditures and ensure that all clinical and quality initiatives are delivered within budget while maintaining high operational standards.

ADDITIONAL FUNCTIONS:

- Supervises, monitors, trains, evaluates, and corrects personnel, among others to comply with his/her role as a supervisor,



to ensure 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: Doctor of Pharmacy (PharmD) or equivalent degree required. At least five (5) years of progressive leadership experience in managed care pharmacy, clinical program development, or pharmacy quality management, with demonstrated success in applying quality performance metrics. Experienced in managing external vendors and building strong relationships with regulators, clients, and internal leadership. At least three (3) years of experience supervising personnel.

Certifications / Licenses: A valid License and Registration of a Pharmacist & Association of Pharmacists of Puerto Rico is required. Other: In-depth knowledge of CMS, NCQA, HEDIS, STARS measures, and state/federal healthcare regulations. Proficiency in pharmacy benefit systems, clinical data analytics, and population health strategies.

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.”

📌 Pharmacy Clinical & Quality Programs AVP (San Juan)
🏢 MCS Healthcare Holdings, LLC (MCS)
📍 San Juan