Director, Medicare Star Strategy & Execution (Hybrid)

Elevance Health; Ohio; Hybrid; USD 180,000 - 240,000; Full time

Job summary

Elevance Health in the United States is seeking a Director to lead Medicare Star Strategy and Execution within Clinical Pharmacy Strategies. This role directs cross-functional teams, shapes CMS Star interventions, and drives programs to achieve 4-star ratings across Elevance Health contracts in a hybrid work model.

You will oversee predictive rules, data analytics, and collaboration with Care Management, HEDIS, and Clinical Pharmacy Care Center, while supporting sales, budgeting, and talent

Qualifications

• Requires PharmD, RPh or MPh and minimum of 5 years of managed care experience; or any combination of education and experience, which would provide an 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 Measures

Vendor Management

Data Analysis

Excel Dashboards

Stakeholder Management

Cross-functional Collaboration

Communication Skills

Education

PharmD

BS in Pharmacy

Tools

Excel

Job description

Elevance Health in the United States is seeking a Director to lead Medicare Star Strategy and Execution within Clinical Pharmacy Strategies. This role directs cross-functional teams, shapes CMS Star interventions, and drives programs to achieve 4-star ratings across Elevance Health contracts in a hybrid work model.

You will oversee predictive rules, data analytics, and collaboration with Care Management, HEDIS, and Clinical Pharmacy Care Center, while supporting sales, budgeting, and talent