Anticipated End Date:2026-09-30
Position Title:Clinical Pharmacy Program Director - Medicare Star Program Management
Job Description:Clinical Pharmacy Program Director - Medicare Star Program ManagementLocation: 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 benefit. In 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:Director Equivalent
Workshift:1st Shift (United States of America)
Job Family:MED > Licensed/Registered Pharmacist/Pharmacy Technician
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.
