VP, Clinical Effectiveness and STARS Quality

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October 26

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ExactCare

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Healthcare Insurance • Pharmaceuticals

ExactCare is a leading pharmacy care management provider that specializes in medication management for individuals with complex, chronic medical needs. With operations in all 50 states and Washington, D. C. , ExactCare supports more than 100,000 people nationwide, helping them manage their medications in assisted living, long-term care facilities, and at home. Partnering with healthcare organizations, ExactCare aims to improve clinical outcomes by ensuring better medication adherence, reducing readmissions, and lowering overall healthcare costs.

501 - 1000 employees

Founded 2009

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

📋 Description

• Drives operational strategies to enhance clinical effectiveness and Stars performance to increase pay for performance revenue for ExactCare Pharmacy • Drives Stars revenue for payers and associated value for ExactCare Pharmacy • Collaborates to establish and manage payer performance expectations including Stars, outcomes, and value-based programs (e.g., quality bonus programs) • Supports network pharmacy contract negotiations with subject matter clinical effectiveness and quality expertise and demonstrated ExactCare Pharmacy performance • Develop and lead clinical effectiveness and Stars quality improvement strategy to support payer value proposition for ExactCare Pharmacy • Serves as expert in understanding Medicare and CMS quality drivers for payer revenue • Design clinical programs aimed at optimizing quality performance and evidence-based care • Provide leadership and direction on clinical effectiveness and quality strategy • Identify, prioritize, and execute on quality initiatives • Interpret quality performance, identify trend, and design improvement strategies • Monitor marketplace trends, literature, professional organizations, and regulatory bodies for new or revised best practices and standards related to clinical effectiveness and pharmacy patient care • Interpret clinical effectiveness and Stars performance metrics, help identify trend, and design improvement strategies • Continually improve and support implementation of clinical effectiveness, quality, and patient safety measurement strategy • Support and facilitate implementation of innovation and systems that improve clinical effectiveness, and Stars experience to drive overall improved pharmacy quality and payer value proposition • Support relationship managers with value proposition to solve patient experience barriers with health plans and PBMs including co-pay differential and medication synchronization fulfillment timing and overrides • Build relationships and advocacy with key external clinical partners within Health Plans and PBMs to stimulate, surface, and shape demand for ExactCare Pharmacy services • Ensure strong clinical effectiveness and quality service levels are achieved to support relationship managers with strong value messages during payer meetings and QBRs. • Stay on top of clinical, quality and Medicare trends and information with health plans and PBMs that can impact the business, keeping leadership and key stakeholders informed of changes (e.g., policy, reimbursements)

🎯 Requirements

• Doctor of Pharmacy Degree • Health Plan/PBM Medicare Quality performance experience. • 10+ years of progressive experience in client relationship management or supporting client relationship owners with clinical program subject matter expertise to drive value from strategic partnerships. • Strong understanding/experience in healthcare, particularly with Medicare quality / safety performance with health plans and PBMs. • Excellent written and verbal communication skills • Proven ability to build and/or support effective partnerships to drive increased value and expanded business opportunities. • Adept at creating productive, long-term customer relationships. • Ability to successfully perform with key decision makers at the Executive/C-Suite level of mid-size and large companies. • Experience conducting presentations to groups • Detail oriented and able to prioritize workload • Strong computer skills including using Word processors, spreadsheets, and database software • Ability to manage multiple priorities and work independently • Demonstrated leadership skills

🏖️ Benefits

• medical/dental/vision • flexible spending • company-paid life insurance and short-term disability • voluntary benefits • 401(k) • Paid Time Off • paid holidays