Director, Pharmacy Quality and Part D Stars

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September 19

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Alignment Health

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Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

📋 Description

• Create and implement a multi-year pharmacy Stars and quality roadmap, aligned with CMS methodology and enterprise Stars goals. • Monitor CMS methodology updates, assess their impact on pharmacy measures, and integrate changes into Stars strategies and operations. • Anticipate emerging trends and proactively adjust strategies to maintain and enhance pharmacy Stars performance. • Lead the development and execution of pharmacy-driven strategies to improve Stars measures and quality outcomes, including medication safety, adherence, MTM, SUPD, SPC, and member experience. • Monitor current performance and evaluate interventions, with added focus on areas of greatest opportunity or risk. • Lead both internal pharmacy programs and PBM/vendor partnerships to ensure high performance and accountability across all Stars-related measures. • Represent Pharmacy in PBM, vendor, and cross-functional forums, ensuring strategies are aligned and Stars performance expectations are achieved. • Build and deliver dashboards, forecasts, and executive reports that translate complex data into actionable insights and recommendations, highlighting risks and guiding Stars performance decisions. • Lead, mentor, and develop a high-performing team, fostering a culture of accountability, innovation, continuous improvement, and optimized workflows that support Stars performance.

🎯 Requirements

• 7+ years of experience in Medicare Part D, Stars, or pharmacy quality, including at least 5 years in leadership roles. • Bachelor’s degree required; Advanced degree preferred (PharmD, RN, MPH, MBA, or related field). • Demonstrated success improving CMS Star Ratings through pharmacy-driven initiatives and PBM/vendor collaboration. • Deep knowledge of CMS Part D Stars methodology, pharmacy quality measures, and regulatory updates that impact performance. • Expertise in leveraging data analytics to guide forecasting, strategy, and decision-making. • Proven ability to lead teams, align cross-functional efforts, and communicate effectively with senior leadership. • Proven ability to anticipate trends, adapt strategies, and deliver measurable improvements in Stars performance and member outcomes. • Ability to communicate positively, professionally and effectively; provide leadership, teach and collaborate with others. • Effective written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees and vendors. • Reasoning skills: prioritize multiple tasks; advanced problem-solving; use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. • Problem-solving, organizational and time management skills; ability to work in a fast-paced environment.