Director, Medicare Star Strategy & Clinical Pharmacy

The Elevance Health Companies, Inc.; Mason (OH); Hybrid; USD 150,000 - 210,000; Full time

Job summary

Elevance Health in the United States is seeking a Director of Clinical Pharmacy Strategies to lead Medicare Star Strategy and Execution. The role requires in-office collaboration three days a week with flexibility for hybrid work arrangements and potential alternate locations for commuting candidates.

You will guide CMS Star program design, analytics, and cost-of-care strategies, while managing budgets, vendor relations, and RFP support to drive 4-star performance across contracts.

Qualifications

• Requires a PharmD, RPh or MPh and minimum of 5 years of managed care experience; or any combination of education and experience providing equivalent background.
• Current unrestricted Pharmacist license in applicable state(s) required.
• Requires BS in Pharmacy.

Responsibilities

• Lead a team who establishes and executes Medicare CMS Star clinical intervention programs to achieve 4 stars for Elevance health contracts
• Serve as the subject matter expert evaluating and implementing clinical quality and cost of care programs
• Manages predictive clinical and economic rule sets used in the pharmacy member and provider communications
• Supports sales and account management and Elevance Health plans in achieving 4 star for individual contracts
• Collaborates with the Care Management, HEDIS, Clinical Pharmacy Care Center to improve medication compliance and achieve corporate goals
• Provides Request for Proposal (RFP) support and assists with business growth and client retention
• Manages budget and increases clinical product revenue
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Skills

CMS Star Ratings

Data analysis

Excel

Vendor relationships

Cross-functional collab

Program management

Stakeholder mgmt

Education

PharmD/RPh/MPh

BS in Pharmacy

Tools

Excel

Job description

Elevance Health in the United States is seeking a Director of Clinical Pharmacy Strategies to lead Medicare Star Strategy and Execution. The role requires in-office collaboration three days a week with flexibility for hybrid work arrangements and potential alternate locations for commuting candidates.

You will guide CMS Star program design, analytics, and cost-of-care strategies, while managing budgets, vendor relations, and RFP support to drive 4-star performance across contracts.