En Triple-S, estamos comprometidos con brindar experiencias laborales significativas para nuestra Gente Valiosa. Nos esforzamos por la excelencia en todo lo que hacemos, desde la forma en que trabajamos juntos hasta la forma en que servimos a nuestros clientes.
Al unirte a Triple-S, serás pieza clave para nuestros esfuerzos de brindar atención médica accesible y de alta calidad, así como también contribuirás a nuestro propósito de habilitar vidas saludables. Servimos a más de a más de 1 millón de asegurados en Puerto Rico, a través de nuestras líneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia.
Construyamos comunidades saludables juntos. ¡Únete a nosotros!
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 Salud Publica or Administracion de Servicios de Salud
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
- No requerido
COMPETENCIES
- Orientado a la Acción
- Colaboración
- Deleite al Cliente
- Inspira confianza
- Maneja la Ambigüedad
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