At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
JOB SUMMARY
Serves as a clinical and operational liaison between the health plan and contracted providers to support appropriate medication utilization, formulary adherence, and evidence-based prescribing practices. This role focuses on education, relationship-building, and clinical alignment to improve patient outcomes while promoting cost-effective medication use across Medicare, Medicaid, and Commercial populations. This position plays a key role in advancing pharmacy strategies, supporting value-based care initiatives, and optimizing pharmacy benefit performance through provider education and engagement.
ESSENTIAL FUNCTIONS
- Serve as a primary pharmacy resource for physicians and clinical staff regarding formulary design and updates, preferred medication use, biosimilar adoption, step therapy and prior authorization processes, and Pharmacy Clinical Strategies.
- Educate providers on evidence-based prescribing aligned with clinical guidelines and best practices, by conducting in-person and virtual educational sessions with provider offices and health systems.
- Promote appropriate medication selection to improve clinical outcomes and cost efficiency.
- Support initiatives focused on, biosimilar optimization, non-formulary drug avoidance, polypharmacy reduction, and waste and duplication reduction.
- Collaborate with internal pharmacy and medical teams to address prescribing trends and opportunities.
- Collaborate with pharmacy and medical teams to address prescribing trends and opportunities.
- Support initiatives aimed at reducing unnecessary specialty drug utilization, improving adherence and persistence, and optimizing pharmacy and medical benefit spend.
- Support implementation of pharmacy programs tied to payer strategy and population health goals.
- Leverage utilization and claims data to identify high-impact providers, target educational interventions, and track trends and performance improvements.
- Ensure provider education aligns with regulations, clinical coverage policies, and internal compliance standards.
EDUCATION
- Bachelor's Degree in Public Health or Health Services Administration
EXPERIENCE
Bachelor’s degree in a healthcare-related or analytical field such as: Public Health, Health Administration, Nursing, Pharmacy, Health Sciences, Business Administration, Economics or Data Science. Master’s degree preferred. One (1) to three (3) years of experience in managed care pharmacy, PBM, or health plan environment.
LICENSES AND CERTIFICATIONS
- None required
COMPETENCIES
- Action Oriented
- Collaborates
- Customer Delight
- Instills Trust
- Manages Ambiguity
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.