Medicare Star Pharmacy Program Director

elevancehealth; Atlanta (GA); Hybrid; USD 200,000 - 260,000; Full time

Job summary

Elevance Health is seeking a Clinical Pharmacy Program Director to lead Medicare CMS Star program management and portfolio strategy. The role focuses on improving quality, cost of care, and outcomes across retail and medical benefits.

The candidate will oversee CMS Star programs, collaborate with cross-functional teams, and ensure compliance with regulations while driving enterprise-level performance enhancements.

Qualifications

• Requires PharmD and 5+ years in health plan managed care, including 3+ years in management.
• Current unrestricted pharmacy license in applicable state(s).
• MBA is preferred but not required.

Responsibilities

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

Skills

CMS Star knowledge

Stakeholder management

Data-driven decision making

Leadership

Quality improvement

Education

PharmD

Tools

Excel

Job description

Elevance Health is seeking a Clinical Pharmacy Program Director to lead Medicare CMS Star program management and portfolio strategy. The role focuses on improving quality, cost of care, and outcomes across retail and medical benefits.

The candidate will oversee CMS Star programs, collaborate with cross-functional teams, and ensure compliance with regulations while driving enterprise-level performance enhancements.