Senior Director, Pharmacy Clinical & Quality Programs

MCS Health

San Juan (PR)

On-site

USD 120,000 - 180,000

Full time

14 days+

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Job summary

MCS Healthcare Holdings, LLC (MCS) seeks a senior leader to oversee clinical and quality pharmacy programs, including MTM, DMP, CMS STARS, and utilization programs. You will align with pharmacy and clinical leadership to ensure compliant, outcome-driven operations.

This role manages vendor relationships, drives population health initiatives, and guides budget planning while ensuring timely reporting and continuous program improvement across all lines of business.

Qualifications

Doctor of Pharmacy (PharmD) or equivalent degree required.
At least eight (8) years of progressive leadership experience in managed care pharmacy, clinical program development, or pharmacy quality management, with demonstrated success in applying quality performance metrics.
At least five (5) years of experience supervising personnel.

Responsibilities

Oversee Clinical Services, Pharmacy Utilization, and Account Management programs, ensuring compliance with federal, state, and local regulations, as well as organizational policies and procedures.
Support the development, execution, and ongoing enhancement of clinical pharmacy programs, ensuring alignment with departmental objectives, quality standards, and member needs.
Oversee delegated vendor activities related to MTMP, Integrated Diabetes Program, Specialty Pharmacy Interventions, DMP/DPP, and CMS STARS measures, monitoring performance and compliance with contractual and regulatory requirements.
Coordinate the implementation and monitoring of clinical and quality pharmacy programs to ensure adherence to CMS, NCQA, and other applicable regulatory standards.
Collaborate with other internal departments to ensure effective integration of pharmacy programs with broader care management, quality improvement, and population health initiatives.
Manage the Pharmacy Account Management function, ensuring timely resolution of client and internal inquiries, operational effectiveness, and delivery of high-quality service across all lines of business.
Monitor program performance metrics, quality outcomes, operational effectiveness, and regulatory compliance indicators. Prepare reports and recommendations for pharmacy leadership to support decision-making and continuous improvement efforts.
Represent the Department in operational meetings, client discussions, vendor reviews, and cross-functional committees. Present program results, operational updates, and compliance activities to leadership and stakeholders.