Clinical Quality Assurance & Training

Job Description

Job Description

Position Type: Full-Time, In-Office (Nashville)

Department: Pharmacy Operations & Product Support Team

Reports To: Director, Pharmacy Operations

Position Summary

The Quality Assurance & Training Specialist is responsible for developing and delivering training programs while driving quality assurance initiatives across the Pharmacy Operations team. This role partners closely with Pharmacy Support Specialists (PSS), Supervisors, and Operations leadership to ensure team members consistently deliver exceptional service, accurate work, and compliant processes.

The specialist plays a critical role in onboarding new employees, providing ongoing education, monitoring quality performance, identifying skill gaps, and recommending targeted coaching and process improvements. This position is an individual contributor with significant influence across the organization and does not have direct supervisory responsibilities.

• Coordinate and facilitate new hire onboarding and training programs for Pharmacy Support Specialists and other operations staff.
• Develop and maintain training materials, job aids, reference guides, and standard operating procedures.
• Evaluate trainee performance and provide constructive feedback throughout the onboarding process.
• Partner with Operations leaders to ensure employees are fully prepared before transitioning to production.
• Design and deliver ongoing education to reinforce operational knowledge, customer service skills, and process changes.
• Lead refresher training based on quality findings, operational trends, regulatory updates, and new client implementations.
• Support cross-training initiatives to increase operational flexibility.

• Conduct regular quality reviews of inbound calls, case documentation, and operational workflows.
• Evaluate employee performance against established quality standards and service expectations.
• Document quality findings and identify trends, recurring issues, and opportunities for improvement.
• Provide actionable feedback to supervisors and employees to improve performance.
• Partner with Operations leadership to create targeted coaching and development plans.
• Monitor effectiveness of training through quality metrics and performance outcomes.
• Participate in calibration sessions to ensure consistency in quality scoring.

• Analyze quality data to identify operational risks and recurring process issues.
• Recommend improvements to workflows, training programs, and documentation.
• Assist in developing quality scorecards, performance dashboards, and reporting.
• Support implementation of new clients, products, and operational processes.
• Collaborate with Clinical Operations, Compliance, Client Services, and Technology teams to ensure training reflects current business processes.
• Promote a culture of continuous learning, operational excellence, and customer-focused service.

• Bachelor's degree or equivalent combination of education and experience.
• 3–5 years of experience in healthcare, pharmacy benefit management (PBM), managed care, call center operations, or a related field.
• Experience delivering employee training and facilitating classroom or virtual learning.
• Experience performing quality assurance evaluations or coaching employees.
• Strong written and verbal communication skills.
• Excellent presentation and facilitation abilities.
• Strong organizational and project management skills.
• Ability to analyze data and identify performance trends.
• Proficiency with Microsoft Office, particularly Excel and PowerPoint.

• Experience in prior authorization, pharmacy operations, or PBM environments.
• Experience working with learning management systems (LMS).
• Experience using CRM platforms such as Salesforce.
• Knowledge of HIPAA and healthcare regulatory requirements.
• Adult learning or instructional design experience.