Director, Pharmacy

About the role

The Director, Part D Stars Strategy, is responsible for driving the day-to-day strategy, execution, and performance management of Medicare Part D Star Ratings. This role serves as the operational and analytical lead for Part D Stars, translating CMS requirements and performance insights into actionable improvement initiatives that support the organization’s goal of achieving and sustaining 4+ Star performance.

Responsibilities

• Part D Stars Strategy & Execution
  • Lead the execution of the Medicare Part D Stars strategy in alignment with organizational goals and CMS technical specifications.
  • Accountable for performance management of Part D Stars measures, including adherence, medication safety, MTM, pharmacy quality measures, and leading indicators/KPIs.
  • Lead, develop, coach and mentor internal Part D Quality & Stars team to achieve enterprise Part D Stars targets.
  • Assess Part D Stars outsourcing opportunities to improve performance as needed.
  • Translate annual CMS updates into operational plans and performance targets.
  • Support multi-year improvement planning and monitor progress against Stars goals.
• Analytics, Reporting & Forecasting
  • Direct development and maintenance of Stars performance dashboards and reporting for leadership and operational teams.
  • Partner with Stars and analytics teams to develop forecasting models, test & learn scenarios, member & provider segmentation, Stars cut point scenarios, and risk assessments.
  • Monitor measure trends and identify emerging risks or improvement opportunities.
• Cross-Functional Collaboration
  • Collaborate with pharmacy operations, PBM partners, clinical programs, Stars and Product teams, and vendors to implement Stars improvement initiatives.
  • Partner with compliance and regulatory teams to support audit readiness and CMS inquiries.
  • Serve as a trusted advisor to leaders by clearly communicating performance insights and recommended actions.

Requirements

• Bachelor's degree or advanced degree (where required) 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.
• Bonus Points (Preferred Qualifications): Master’s degree in Public Health, Pharmacy, Analytics, Business, or a related field preferred.
• 5–8 years of experience in Medicare Part D Stars, pharmacy quality, PBM operations, or health plan analytics.
• Strong working knowledge of Medicare Part D Stars measures, methodology, and CMS technical specifications.
• PharmD, MPH, MS in Analytics, or similar advanced degree.
• Experience with MTM programs, adherence interventions, and pharmacy operations.
• Experience with pharmacy related CAHPS measures and how to drive customer experience improvements to positively impact CAHPS.
• Familiarity with CMS systems and regulatory submissions (e.g., HPMS).
• Experience using tools such as Power BI or Tableau.
• Demonstrated success managing complex, cross-functional teams.
• Strong analytical and problem-solving skills with experience interpreting performance data and forecasts.
• Effective written and verbal communication skills, including experience presenting to senior leaders.

Qualifications

• Bachelor's degree or advanced degree (where required) 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.
• Bonus Points (Preferred Qualifications): Master’s degree in Public Health, Pharmacy, Analytics, Business, or a related field preferred.
• 5–8 years of experience in Medicare Part D Stars, pharmacy quality, PBM operations, or health plan analytics.
• Strong working knowledge of Medicare Part D Stars measures, methodology, and CMS technical specifications.
• PharmD, MPH, MS in Analytics, or similar advanced degree.
• Experience with MTM programs, adherence interventions, and pharmacy operations.
• Experience with pharmacy related CAHPS measures and how to drive customer experience improvements to positively impact CAHPS.
• Familiarity with CMS systems and regulatory submissions (e.g., HPMS).
• Experience using tools such as Power BI or Tableau.
• Demonstrated success managing complex, cross-functional teams.
• Strong analytical and problem-solving skills with experience interpreting performance data and forecasts.
• Effective written and verbal communication skills, including experience presenting to senior leaders.

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs.
• Paid Time Off (PTO).
• Competitive health benefits and wellness programs.

Pay

$157,978.00 - $252,765.00

Schedule

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.

Skills

• Clinical Process Improvement
• Healthcare Management
• Managed Care
• Medicare Regulations
• Medication Management
• Pharmaceutical Industry
• Pharmacy
• Pharmacy Benefits Management (PBM)
• Pharmacy Compliance
• Pharmacy Management
• Pharmacy Operations
• Policy Development
• Quality Care
• Quality Management
• Regulatory Compliance
• Specialty Pharmacies