Medicare CMS Star Programs Director

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

Job summary

Elevance Health seeks a Clinical Pharmacy Program Director to lead Medicare CMS Star initiatives across retail and medical benefits, driving quality, cost of care, and outcomes. You will oversee the Star portfolio, align enterprise strategy, and ensure regulatory compliance with stakeholders.

The position requires a PharmD with 5+ years in health-plan managed care, including 3+ years in management, and an active pharmacist license.

Qualifications

• Requires PharmD with health plan managed care experience.
• Minimum 3 years in management and 2 years clinical experience.
• Current unrestricted RPh license in applicable state(s).

Responsibilities

• Develops and implements Medicare CMS Star initiatives and procedures.
• Serves as subject matter expert for CMS Star implementations.
• Establishes processes to monitor quality of care and compliance.
• Addresses program and Medicare contract performance to hit targets.
• Supports sales and account management for Elevance Health plans.
• Builds relationships with internal and external stakeholders.
• Interfaces with claim and medical management systems for high-risk claims.

Skills

CMS Star knowledge

Vendor management

Program management

Data analysis

Excel proficiency

Stakeholder collaboration

Cross-functional leadership

Education

PharmD

Tools

Excel

Job description

Elevance Health seeks a Clinical Pharmacy Program Director to lead Medicare CMS Star initiatives across retail and medical benefits, driving quality, cost of care, and outcomes. You will oversee the Star portfolio, align enterprise strategy, and ensure regulatory compliance with stakeholders.

The position requires a PharmD with 5+ years in health-plan managed care, including 3+ years in management, and an active pharmacist license.