Director, Pharmacy Quality - Medicare Part D Star

Job Description

SUMMARY:


This position is responsible for the Medication Adherence program for BCBSM senior members.

The Director will design and execute a multi-year strategy that improves adherence rates and achieves Star measure performance goals. The Director will report to the Managing Director of Pharmacy Quality and oversee a large, multidisciplinary team of pharmacists, pharmacy technicians, data analysts, and external vendors. This role requires strong cross-functional collaboration with clinical, operations, IT, finance, and external partners to integrate adherence initiatives, drive performance, and apply emerging digital tools and analytics to scale impact. The ideal candidate combines deep pharmacy expertise with proven leadership, strategic thinking, change-management skills and the ability to influence stakeholders at all levels.

Medicare Part D Star experience required, medication adherence experience preferred

RESPONSIBILITIES/TASKS:

• Serves as the department lead and subject-matter expert for CMS Star Medication Adherence measure performance; interpret technical specifications and activities designed to maximize star scores.


• Leads the creation and execution of a multi-year strategic plan that leveraging emerging technologies (e.g., digital adherence platforms, analytics, AI-driven insights) to scale program impact and improve Star-measure performance.


• Drives collaboration with pharmacy leadership to integrate adherence initiatives across all pharmacy touchpoints (adherence, care management, formulary inquiries, etc.).


• Manages, supervises, sets performance goals/objectives, monitors performance, evaluates, and mentors clinical and non-clinical staff.


• Oversees all vendor contracts, negotiates and develops service-level agreements, and continuously monitors vendor performance against agreed metrics.


• Conducts periodic business analyses; recommends and implements efficiency improvements, including evaluation of vendor solutions versus in-sourcing options.


• Creates, maintains, and updates departmental policies, procedures, and documentation to satisfy regulatory and compliance requirements.


• Develops and disseminates communications for internal and external stakeholders, including presentations, educational programs, and marketing materials.


• Prepares, reviews, and conducts presentations or educational programs to various audiences, including providers, external partners and internal teams.

• Participates in the development of the annua departmental budget, oversees expenditures, identifies variances, investigates root cause and

DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.


EMPLOYMENT QUALIFICATIONS:


EDUCATION:


Bachelor's degree in related field required. Pharm D with residency training is preferred. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.


EXPERIENCE:


Seven years of progressively more responsible experience in a managed care management environment with demonstrated pharmacy and analytic experience that provides the necessary knowledge, skills and abilities. Experience leading diverse teams including clinical staff required. Medicare Part D experience preferred. Prior experience with successfully managing patient/member populations preferred. Experience with vendor management preferred.


SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:


• Thorough knowledge of applicable CMS regulations related Medicare pharmacy benefits. • Decision making, organizational, and problem-solving skills.


• Excellent analytical skills.


• Proficient in current industry standard PC applications and systems (e.g., Word, Excel and PowerPoint).


• Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.


• Ability to work with and empower others on a collaborative basis to ensure success of unit team.


• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.


• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.


• Ability to establish workflows, manages multiple projects, and meets necessary deadlines.


WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.


PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $126,400 and $211,800.

EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.


Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.