Director, Pharmacy

Overview

Director, Part D Stars Strategy within the Government Pharmacy Programs Department responsible for driving day-to-day strategy, execution, and performance management of Medicare Part D Star Ratings. Translates CMS requirements and performance insights into actionable improvement initiatives to achieve and sustain 4+ Star performance. Partners with Pharmacy Operations, Analytics, PBM Partners, Product, and Stars teams and leads the internal Quality & Stars team to ensure attainment of Part D Stars targets.

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.

Cross-Functional 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.

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.

• Master's degree in Public Health, Pharmacy, Analytics, Business, or a related field preferred.
• 5-8 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, cross functional teams.
• Strong analytical and problem-solving skills with experience interpreting performance data and forecasts.
• Effective written and verbal communication skills, including experience presenting to senior leaders.

• The opportunity to work at the cutting edge of health care delivery with a team that's 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

• 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 that's flexible, connected, and future focused.
• In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection.
• In a Remote Flex role, you'll 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…