Clinical Pharmacy Program Director - Medicare Star Program Management

The Elevance Health Companies, Inc.; Atlanta (GA); Hybrid; USD 180,000 - 240,000; Full time

Benefits offered by this job

Health insurance

401(k) + match

Stock purchase plan

Job summary

Elevance Health seeks a Director-equivalent leader to drive Medicare CMS Star program management, ensure quality and cost of care improvements, and oversee portfolio strategy across retail and medical benefits.

The role requires PharmD with 5+ years managed care experience, 3+ years in management, and an unrestricted RPh license. MBA and strong data analytics are highly valued in a hybrid in-office role.

Qualifications

• PharmD required with health plan/managed care experience preferred.
• Active RPh license in applicable state(s) required.
• MBA preferred or strong CMS Star knowledge is a plus.

Responsibilities

• Lead, develop, and implement CMS Star initiatives and programs to improve quality and cost of care.
• Serve as SME for CMS Star program implementations and performance monitoring.
• Ensure compliance and address quality of care issues across Star programs.
• Manage vendor relationships and contractual performance for program success.
• Collaborate with Quality, Pharmacy, Operations, Analytics, and Leadership teams.

Skills

CMS Star ratings

Program management

Vendor management

Data analysis

Stakeholder management

Cross-functional collaboration

Excel proficiency

Education

Doctor of Pharmacy (PharmD)

Active Pharmacist license (RPh)

Tools

Excel

Job description

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 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 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.

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.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• 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
• financial education resources

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.

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.

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.