Director, Pharmacy
Job Location:
Durham, NC - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
Job Description
Were seeking a Director Part D Stars Strategy to join our Government Pharmacy Programs Department. The Director Part D Stars Strategy is responsible for driving the day to day strategy execution and performance management of Medicare Part D Star Ratings. This role serves as the operational and analytical lead for Part D Stars translating CMS requirements and performance insights into actionable improvement initiatives that support the organizations goal of achieving and sustaining 4 Star performance.You will partner closely with Pharmacy Operations Analytics PBM Partners Product and Stars team and plays a critical role in enabling informed decision making through data analytics forecasting segmentation and program oversight. The Director will also lead our internal Quality & Stars team overseeing team performance professional development progress against goals and ensuring attainment of Part D Stars targets.
What Youll Do
Part D Stars Strategy & Execution
- Lead the execution of the Medicare Part D Stars strategy in alignment with organizational goals and CMS technical specifications.
- Accountable for performance management of Part D Stars measures including adherence medication safety MTM pharmacy quality measures and leading indicators/KPIs.
- Lead develop coach and mentor internal Part D Quality & Stars team to achieve enterprise Part D Stars targets.
- Assess Part D Stars outsourcing opportunities to improve performance as needed.
- Translate annual CMS updates into operational plans and performance targets.
- Support multiyear improvement planning and monitor progress against Stars goals.
Analytics Reporting & Forecasting
- Direct development and maintenance of Stars performance dashboards and reporting for leadership and operational teams.
- Partner with Stars and analytics teams to develop forecasting models test & learn scenarios member & provider segmentation Stars cut point scenarios and risk assessments.
- Monitor measure trends and identify emerging risks or improvement opportunities.
CrossFunctional Collaboration
- Collaborate with pharmacy operations PBM partners clinical programs Stars and Product teams and vendors to implement Stars improvement initiatives.
- Partner with compliance and regulatory teams to support audit readiness and CMS inquiries.
- Serve as a trusted advisor to leaders by clearly communicating performance insights and recommended actions.
What You Bring
- Bachelors degree or advanced degree (where required)
- 8 years of experience in related field.
- In lieu of degree 10 years of experience in related field.
Bonus Points(Preferred Qualifications)
- Masters degree in Public Health Pharmacy Analytics Business or a related field preferred.
- 58 years of experience in Medicare Part D Stars pharmacy quality PBM operations or health plan analytics.
- Strong working knowledge of Medicare Part D Stars measures methodology and CMS technical specifications.
- PharmD MPH MS in Analytics or similar advanced degree.
- Experience with MTM programs adherence interventions and pharmacy operations.
- Experience with pharmacy related CAHPS measures and how to drive customer experience improvements to positively impact CAHPS.
- Familiarity with CMS systems and regulatory submissions (e.g. HPMS).
- Experience using tools such as Power BI or Tableau.
- Demonstrated success managing complex crossfunctional teams.
- Strong analytical and problemsolving skills with experience interpreting performance data and forecasts.
- Effective written and verbal communication skills including experience presenting to senior leaders.
What Youll Get
- The opportunity to work at the cutting edge of health care delivery with a team thats deeply invested in the community
- Work-life balance flexibility and the autonomy to do great work
- Medical dental and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
- Learn more
Where Youll Work
- Our Hybrid Flex approach is built on presence with a purpose giving you flexibility to work remotely with intentional in-person connection that supports a workplace thats flexible connected and future focused.
- In a Hybrid-Flex role youll work in the office at least two days a week for collaboration and connection.
- In a Remote Flex role youll work virtually with a few in-office visits each year for meaningful moments that matter.
- Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting(Onsite expectations will be discussed during the interview process).
Salary Range
At Blue Cross NC we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training specialized skill sets licensure and certifications and other business and organizational base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus* 401(k) with employer match Paid Time Off (PTO) and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Clinical Process Improvement Healthcare Management Managed Care Medicare Regulations Medication Management Pharmaceutical Industry Pharmacy Pharmacy Benefits Management (PBM) Pharmacy Compliance Pharmacy Management Pharmacy Operations Policy Development Quality Care Quality Management Regulatory Compliance Specialty Pharmacies
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Required Experience:
Director
About Company
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