Quality Manager

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. 

Join us in improving health care outcomes for all!  We promise to do what’s right, always. 

Position Summary: 

The Quality Manager oversees and implements quality management programs to ensure compliance and high standards across healthcare operations. This role leads quality improvement initiatives to enhance patient care, streamline processes, and support overall organizational goals. The Quality Manager analyzes and interprets data to identify trends, uncover opportunities, and drive measurable improvements across healthcare and pharmacy benefit management services. This position also monitors and updates policies and procedures to ensure alignment with regulatory requirements and industry best practices. The Quality Manager collaborates with cross-functional teams to address challenges, develop solutions, and implement effective, sustainable process improvements. 

 What you will do: 

Quality Improvement Programs:  

• Develop, implement, and manage quality improvement initiatives to enhance patient care and operational effectiveness 

• Identify performance gaps and lead projects that drive measurable improvements and outcomes 

• Apply Lean, Six Sigma, and root cause analysis methodologies to streamline processes 

• Foster a culture of continuous improvement and accountability across the organization 

Regulatory Compliance and Standards:  

• Ensure quality programs align with federal, state, industry regulations and standards, as well as accreditation requirements 

• Work with the compliance team to integrate regulatory and accreditation updates into policies, procedures, and workflows 

• Establish, implement and maintain quality assurance processes to evaluate compliance and reduce risk 

• Partner with leadership to address compliance issues and implement corrective actions 

Data Analysis and Performance Reporting: 

• Analyze and interpret quality, operational, and patient care data to identify trends and opportunities 

• Develop and maintain dashboards, reports, and key performance indicators (KPIs) 

• Use data insights to support strategic decision-making and continuous improvement efforts 

• Present findings, recommendations, and progress updates to leadership and stakeholders 

Cross-Functional Collaboration and Communication:  

• Partner with clinical, operational, and pharmacy benefit management teams to improve processes 

• Facilitate meetings, training, and education to support quality initiatives and best practices 

• Communicate goals, progress, and outcomes clearly to diverse audiences 

• Support change management and ensure successful implementation of quality programs 

What you need: 

• Bachelor’s degree in healthcare administration, business administration, public health, or related fields  

• 5+ years of experience in quality management, healthcare operations, or related roles 

• Proficiency in analyzing and interpreting data to identify trends and drive improvements in patient care processes 

• Experience with data analysis tools and familiarity with pharmacy benefit management (PBM) or healthcare systems 

• Knowledge of quality improvement methodologies, including Lean, Six Sigma, and root cause analysis, to optimize processes 

• Strong written and oral communication skills for clear reporting, training, and stakeholder engagement 

• Ability to collaborate effectively with diverse cross-functional teams to achieve shared goals and elevate standards 

• Skilled at identifying issues, developing solutions, and implementing process changes efficiently 

• Demonstrated dedication to continuous improvement and a commitment to operational excellence 

 What you get: 

• To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes 

• To work in a culture where people thrive because when OUR team thrives, OUR business thrives 

• Competitive compensation, including health, dental, vision and other benefits 

 Note:   

AffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.