Clinical Pharmacy Program Director - Medicare Star Program Management
Core
Leading and implementing Medicare CMS Star pharmaceutical management initiatives to improve healthcare quality, cost of care, and outcomes for retail and medical benefit members.
Role type
Director-level clinical pharmacy program manager
Builds
Enterprise and contract-level pharmacy CMS Star strategies and performance programs
Domain
US Healthcare / Medicare Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Medicare CMS Star program management, health plan managed care strategy, clinical pharmacy operations, compliance monitoring, contract performance management, high-risk claim identification
Preferred skills
MBA, 4-Star performance achievement, root cause analysis, data-driven intervention design, vendor relationship management, Excel data analysis and dashboard development, cross-functional program leadership
Technologies
Excel
Responsibilities
Develop and implement CMS Star initiatives and operational procedures, serve as subject matter expert for CMS Star implementations, establish processes to monitor compliance and quality of care, address and resolve program performance issues to achieve targets, support sales and account management for health plans, interface with claim and medical management systems experts
Seniority
Director, strategic execution & team leadership