Essential Functions
• Direct, coach, and develop team members through regular 1:1 meetings.
• Complete performance reviews, coaching documentation, and corrective
actions.
• Manage staffing, schedules, queue performance, and workload balancing.
• Review KPIs including Quality, AHT, Productivity, Attendance, and SLA.
• Identify training opportunities and partner with Learning & Development.
• Handle escalated member, provider, and client concerns.
• Monitor daily operational performance against SLA, productivity, quality, and
schedule adherence goals.
• Ensure compliance with HIPAA, CMS, state board of pharmacy requirements,
and internal policies.
• Use reporting to identify trends and recommend corrective actions.
• Partner with Workforce Management, Training, Operations, and Leadership.
• Support continuous improvement initiatives and standardization efforts.
• Maintain documentation and confidentiality standards.
• Participate in calibration sessions and business meetings.
• Lead or support special projects as assigned.
• Review clinical decision-making for compliance with pharmacy standards.
• Validate prescription verification accuracy and medication safety practices.
Knowledge, Skills, and Abilities
• Strong written and verbal communication.
• Leadership and relationship-building skills.
• Critical thinking and analytical ability.
• Ability to prioritize competing demands.
• Experience working across multiple pharmacy systems.
• Proficiency with Microsoft Office, particularly Excel.
• Ability to maintain confidentiality.
Minimum Qualifications
• BS Pharmacy or PharmD.
• Active Arizona or Texas Pharmacist License in good standing (Required).
• Three or more years of relevant PBM, specialty pharmacy, participant services,
or healthcare operations experience.
• Previous leadership or quality experience appropriate to the role.
Preferred Qualifications
• PBM or specialty pharmacy experience.
• Call center healthcare operations experience.
• Lean/Six Sigma or process improvement exposure.
• Experience presenting operational metrics.
• URAC, ACHC, or NCQA familiarity.
Performance Measures
• Quality audit performance
• Productivity and throughput
• Service Level (SLA) attainment
• Attendance and schedule adherence
• Compliance and documentation accuracy
• Customer experience
• Coaching effectiveness and continuous improvement
Work Environment & Physical Requirements
Fast-paced, computer-based participant services environment requiring
prolonged sitting, frequent computer use, telephone communication, and the
ability to manage multiple priorities while maintaining accuracy and
professionalism.

If you've got the skills to succeed and the motivation to make it happen, we look forward to hearing from you.