Quality Manager

Role Overview

• Lead and continuously mature the organization’s Internal Quality & Audit Program, encompassing telephonic quality monitoring and operational process audits.
• Establish audit governance, methodologies, sampling strategies, scoring frameworks, and reporting standards across all audit activities.
• Ensure audit activities align with regulatory requirements, accreditation standards, and organizational risk priorities.
• Promote a culture of quality, accountability, and continuous improvement that prioritizes patient safety and harm prevention.
• Oversee the established call quality auditing program, including supervision of the Pharmacy Quality Supervisor and audit team.
• Ensure consistent scoring, calibration, and inter-rater reliability across call evaluations.
• Validate adherence to communication standards, patient education requirements, scripting, and compliance protocols.
• Monitor for and address communication breakdowns that could contribute to medication errors, delayed therapy or patient harm.
• Partner with call center leadership to translate audit findings into coaching strategies, training initiatives, and performance improvement plans.
• Monitor program effectiveness and implement enhancements to improve scoring accuracy, efficiency, and operational impact.
• Support implementation, management, and effective utilization of quality management systems.
• Conduct risk-based audits to evaluate process integrity, documentation accuracy, and adherence to policies and standards.
• Identify process vulnerabilities that could lead to medication errors, therapy delays, privacy breaches, or other patient safety risks.
• Develop and maintain audit tools, checklists, and protocols to ensure consistency and scalability.
• Design, implement, and maintain a comprehensive internal audit framework for specialty pharmacy workflows, including patient intake and benefits investigation; clinical review and documentation; prior authorization and payer requirements; dispensing, verification, fulfillment, and inventory processes; patient onboarding, counseling, and adherence programs; and accreditation compliance.
• Analyze audit findings to identify trends, systemic risks, performance gaps, and improvement opportunities.
• Develop dashboards and reports that translate audit data into actionable insights for leadership and operational teams.
• Lead root cause analysis and partner with stakeholders to implement corrective and preventive action plans (CAPAs).
• Monitor effectiveness of improvement initiatives and adjust audit focus based on outcomes.
• Provide audit insights to Risk Management and Compliance teams to support proactive risk identification and mitigation.
• Identify control gaps in new or evolving workflows and recommend safeguards.
• Escalate high-risk findings and track resolution to completion.
• Establish policies, procedures, and documentation standards for audit activities.
• Travel up to 25-50% to pharmacy sites, with occasional travel to conferences.
• Other duties as assigned.

Requirements

• Bachelor’s degree in healthcare administration, pharmacy, nursing, quality management, or a related field, or equivalent work experience, required.
• Lean, Six Sigma, or quality improvement certification preferred.
• 5+ years of progressive experience in healthcare quality, auditing, compliance, or specialty pharmacy operations required.
• 3+ years of experience in coaching, mentoring, and/or leading others required.
• Demonstrated experience developing or managing quality audit programs required.
• Experience with specialty pharmacy accreditation standards (e.g., URAC, ACHC, or similar) required.
• Experience with call center quality monitoring platforms and audit tools preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5%
• No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!