Director, Clinical Pharmacy Stars Performance

The role demands clinical credibility and independent clinical judgment on complex medication management strategies.

7+ years of progressive leadership in managed care, a health plan, or a PBM

, with dedicated ownership of Medicare Advantage and Part D quality programs and a documented, quantifiable track record of moving clinical pharmacy Stars measures in a volatile cut point environment.

You will roll up your sleeves to manipulate raw data, draft a workflow, or personally audit a vendor's call dispositions.

Advanced analytical acumen and the ability to see past the surface of a dashboard to the root cause of non-adherence, then design the targeted, cost-effective intervention that addresses it.

Comfort with business intelligence tooling and with sizing an opportunity before committing resources to it.

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

Employer sponsored health, dental and vision plan with low or no premium

Generous paid time off

$100 monthly mobile or internet stipend

Stock options for all employees

As Director, Clinical Pharmacy Stars Performance, you are the tactical owner of every clinical pharmacy-related measure in our Medicare Advantage and Part D Star Ratings portfolio.

Your job is to drive our clinical pharmacy Stars enterprise strategy into daily reality, measure by measure, member by member, week by week.

You will be the enterprise clinical subject matter expert on pharmacy quality: the person Medical Directors call before they call anyone else, the person who reads the Technical Notes the day they drop, and the person who can tell us in February where a cut point is going to land in October and what we need to do about it now.

You will report directly to the AVP, Pharmacy, carrying the portfolio into executive meetings, leading cross-functional escalations, and owning outcomes.

Performance Management & Insight Generation.

Own the performance trajectory of the full clinical pharmacy Star portfolio, including the triple-weighted medication adherence measures (Diabetes, RAS Antagonists, Statins), Statin Use in Persons with Diabetes (SUPD), Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH), and Concurrent Use of Opioids and Benzodiazepines (COB).