Director, Pharmacy

Overview Director, Part D Stars Strategy within the Government Pharmacy Programs Department responsible for driving day-to-day strategy, execution, and performance management of Medicare Part D Star Ratings. Translates CMS requirements and performance insights into actionable improvement initiatives to achieve and sustain 4+ Star performance. Partners with Pharmacy Operations, Analytics, PBM Partners, Product, and Stars teams and leads the internal Quality & Stars team to ensure attainment of Part D Stars targets. What You'll Do Part D Stars Strategy & Execution Lead the execution of the Medicare Part D Stars strategy in alignment with organizational goals and CMS technical specifications. Accountable for performance management of Part D Stars measures, including adherence, medication safety, MTM, pharmacy quality measures, and leading indicators/KPIs. Lead, develop, coach and mentor internal Part D Quality & Stars team to achieve enterprise Part D Stars targets. Assess Part D Stars outsourcing opportunities to improve performance as needed. Translate annual CMS updates into operational plans and performance targets. Support multiyear improvement planning and monitor progress against Stars goals. Analytics, Reporting & Forecasting Direct development and maintenance of Stars performance dashboards and reporting for leadership and operational teams. Partner with Stars and analytics teams to develop forecasting models, test & learn scenarios, member & provider segmentation, Stars cut point scenarios, and risk assessments. Monitor measure trends and identify emerging risks or improvement opportunities. Cross-Functional Collaboration Collaborate with pharmacy operations, PBM partners, clinical programs, Stars and Product teams, and vendors to implement Stars improvement initiatives. Partner with compliance and regulatory teams to support audit readiness and CMS inquiries. Serve as a trusted advisor to leaders by clearly communicating performance insights and recommended actions. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points (Preferred Qualifications) Master's degree in Public Health, Pharmacy, Analytics, Business, or a related field preferred. 5-8 years of experience in Medicare Part D Stars, pharmacy quality, PBM operations, or health plan analytics. Strong working knowledge of Medicare Part D Stars measures, methodology, and CMS technical specifications. PharmD, MPH, MS in Analytics, or similar advanced degree. Experience with MTM programs, adherence interventions, and pharmacy operations. Experience with pharmacy related CAHPS measures and how to drive customer experience improvements to positively impact CAHPS. Familiarity with CMS systems and regulatory submissions (e.g., HPMS). Experience using tools such as Power BI or Tableau. Demonstrated success managing complex, crossfunctional teams. Strong analytical and problem-solving skills with experience interpreting performance data and forecasts. Effective written and verbal communication skills, including experience presenting to senior leaders. What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work Medical, dental, and vision coverage along with numerous health and wellness programs Parental leave and support plus adoption and surrogacy assistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Where You'll Work Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused. In a Hybrid-Flex role, you\'ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you\'ll work virtually, with a few in-office visits each year for meaningful moments that matter. Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting (Onsite expectations will be discussed during the interview process). Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. 157,978.00 - 252,765.00 Skills Clinical Process Improvement, Healthcare Management, Managed Care, Medicare Regulations, Medication Management, Pharmaceutical Industry, Pharmacy, Pharmacy Benefits Management (PBM), Pharmacy Compliance, Pharmacy Management, Pharmacy Operations, Policy Development, Quality Care, Quality Management, Regulatory Compliance, Specialty Pharmacies #J-18808-Ljbffr