Clinical Pharmacy Program Director Medicare Star Program Management

Anticipated End Date:

Position Title:

Job Description:

Clinical Pharmacy Program Director - Medicare Star Program Management

Location: This role requires associates to be in-office 3 days per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.

The Clinical Pharmacy Program Director is responsible for leading developing and implementing Medicare CMS Star pharmaceutical management initiatives and processes that impact health care quality cost of care and outcomes for all aspects of the retail and medical addition also oversees the pharmacy CMS Star Portfolio including enterprise and contract level strategy execution and performance while maintaining compliance with all related regulations and guidance.

How you will make an impact:

• Develops and implements Medicare CMS Star initiatives/programs and operation procedures to achieve quality efficiency and cost of care goals.
• Serves as the subject matter expert for CMS Star program implementations.
• Establishes processes to monitor compliance and quality of care issues for CMS Star programs.
• Addresses and resolves program and Medicare contract performance to achieve target.
• Supports sales and account management for Elevance health plans.
• Builds effective relationships with internal and external stakeholders.
• Interfaces with claim and medical management systems experts to assist in the early identification of high-risk pharmacy claims.

Minimum Requirements:

Requires a PharmD and minimum of 5 years of health plan managed care experience which includes minimum of 3 years of management experience preferably in managed care and minimum of 2 years of clinical experience; or any combination of education and experience which would provide an equivalent background. Current unrestricted license to practice pharmacy as a RPh in applicable state(s) required.

Preferred Skills Capabilities and Experience:

• MBA preferred.
• Demonstrated expertise in CMS Medicare Star Ratings measures methodology and strategies to improve quality and performance outcomes including experience achieving 4-Star performance along with experience establishing ongoing performance monitoring processes conducting root cause analysis identifying performance gaps uncovering improvement opportunities and implementing data-driven interventions to enhance quality operational and business outcomes is strongly preferred.
• Demonstrated ability to manage vendor relationships oversee contractual performance drive accountability and ensure successful execution of programs through quality assurance processes closed-loop reviews performance validation and ongoing program optimization is strongly preferred.
• Strong proficiency in Excel including data analysis dashboard development reporting trend analysis performance tracking and the ability to translate data into actionable recommendations identify trends measure program effectiveness and support business decision-making is strongly preferred.
• Demonstrated program management experience leading complex cross-functional initiatives driving execution managing competing priorities and ensuring successful delivery of strategic objectives while achieving key business and quality outcomes is strongly preferred.
• Demonstrated ability to influence and collaborate effectively across Quality Pharmacy Operations Analytics Clinical and Executive Leadership teams combined with strong communication stakeholder management accountability flexibility and problem-solving skills strongly preferred.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.

We offer a range of market-competitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13 the posting will automatically come down on 3/12 at 11:59:59 other words the job is posted until 3/13 not through 3/13.