Director, Pharmacy

🔥 0 minutes ago

🐎 Kentucky, Louisiana, +2 more states – Remote

🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🎸 Mississippi – Remote 🌴 South Carolina – Remote

💵 $158k - $252.8k / year

⏰ Full Time

🔴 Lead

💊 Pharmacist

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Drive the day-to-day strategy, execution, and performance management of Medicare Part D Star Ratings • Lead execution of the Medicare Part D Stars strategy in alignment with organizational goals and CMS technical specifications • Manage Part D Stars measures, including adherence, medication safety, MTM, pharmacy quality measures, and leading indicators/KPIs • Lead, develop, coach, and mentor the internal Part D Quality & Stars team • Assess Part D Stars outsourcing opportunities • Translate annual CMS updates into operational plans and performance targets • Support multi-year improvement planning and monitor progress against Stars goals • Direct development and maintenance of Stars performance dashboards and reporting • Develop forecasting models, test-and-learn scenarios, member and provider segmentation, Stars cut-point scenarios, and risk assessments • Monitor measure trends and identify emerging risks or improvement opportunities • Collaborate with pharmacy operations, PBM partners, clinical programs, Stars and Product teams, and vendors • Partner with compliance and regulatory teams to support audit readiness and CMS inquiries • Advise leaders by communicating performance insights and recommended actions • Oversee team performance, professional development, progress against goals, and attainment of Part D Stars targets

🎯 Requirements

• Bachelor's degree or advanced degree (where required) • 8+ years of experience in a related field • In lieu of degree, 10+ years of experience in a related field • Strong working knowledge of Medicare Part D Stars measures, methodology, and CMS technical specifications • Experience with MTM programs, adherence interventions, and pharmacy operations • Experience with pharmacy-related CAHPS measures and driving customer experience improvements • Familiarity with CMS systems and regulatory submissions, such as HPMS • Experience using 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 presenting to senior leaders • Authorization to work in the United States

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO) • Competitive health benefits and wellness programs