Director, Clinical Pharmacy – Stars Performance

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of the performance trajectory for the complete clinical pharmacy Star portfolio, which encompasses medication adherence measures, SUPD, Poly-ACH, and COB.

• Project measure trajectories against anticipated cut points and identify potential risks several months prior to year-end evaluations.

• Convert performance analysis into daily, weekly, and monthly operational directives for both internal teams and vendors.

• Act as the primary clinical authority on pharmacy quality.

• Monitor changes in regulatory specifications and clinical guidelines, interpreting their operational consequences.

• Facilitate peer-to-peer discussions with clinical leaders at Devoted and within its provider network.

• Keep track of CMS measure development, display-page measures, and the measure developer pipeline.

• Develop data and operational capabilities for future measures while they are still being showcased.

• Analyze Advance Notices, Proposed Rules, and Final Rules, explaining their implications for Devoted.

• Create comprehensive strategies to achieve 5-Star performance across clinical pharmacy measures.

• Identify opportunities to streamline members’ healthcare experiences.

• Oversee operating KPIs and clinical outcome metrics in collaboration with internal teams and external partners, including the PBM.

• Conceptualize and implement clinical and care coordination interventions.

• Lead initiatives from pilot phases to full-scale implementation involving members, providers, and pharmacy networks.

• Assess vendors and platforms for adherence stratification, pharmacist-led interventions, and pharmacy network engagement.

• Propel execution through direct management and influence while providing support to teams.

• Transform complex operational objectives into daily workflows.

⛳️ Requirements

• PharmD or an equivalent clinical degree.

• Over 7 years of progressive leadership experience within managed care, a health plan, or a PBM.

• Proven accountability for Medicare Advantage and Part D quality programs.

• A documented, measurable history of enhancing clinical pharmacy Stars measures in a dynamic cut point environment.

• Proficiency in manipulating raw data, drafting workflows, and auditing vendor call outcomes.

• Advanced analytical skills to identify the root causes of non-adherence and design targeted, cost-effective solutions.

• Familiarity with business intelligence tools and opportunity sizing.

• Proven leadership influence and the ability to impact outcomes across various organizational levels.

• Experience in direct management, leading cross-functional projects, or working within matrix reporting structures.

• Capacity to build consensus without formal authority.

• Ability to engage in nuanced clinical discussions and shape prescribing practices.

• Quick learning aptitude in complex clinical and operational settings.

• Interest in emerging technologies and a practical approach to their application.

• Experience with LLMs for constructing complex prompts and tools is a significant advantage.

• Proficiency and diligence in data analysis, including understanding open versus closed periods, denominator shifts, ranges, and probabilities.

🏝️ Benefits

• Employer-sponsored health, dental, and vision coverage with low or no premium.

• Generous paid time off.

• Monthly stipend of $100 for mobile or internet expenses.

• Stock options available for all employees.

• Parental leave program.

• 401K program.

• Additional offerings in the total rewards package.

• A supportive and equal opportunity work environment.