Director, Clinical Pharmacy Stars Performance

Devoted Health • Waltham, MA

4d • $182,000 - $247,000

About The Position

As Director, Clinical Pharmacy Stars Performance, you are the tactical owner of every clinical pharmacy-related measure in our Medicare Advantage and Part D Star Ratings portfolio. Your job is to drive our clinical pharmacy Stars enterprise strategy into daily reality, measure by measure, member by member, week by week. This is the most consequential set of measures we own.
You will be the enterprise clinical subject matter expert on pharmacy quality: the person Medical Directors call before they call anyone else, the person who reads the Technical Notes the day they drop, and the person who can tell us in February where a cut point is going to land in October and what we need to do about it now. You will also be the person building the tracker, setting the objectives and key results, and personally auditing whether the outreach was actually effective.
You will report directly to the AVP, Pharmacy, carrying the portfolio into executive meetings, leading cross-functional escalations, and owning outcomes.

Requirements

• PharmD or equivalent clinical degree. The role demands clinical credibility and independent clinical judgment on complex medication management strategies.
• 7+ years of progressive leadership in managed care, a health plan, or a PBM, with dedicated ownership of Medicare Advantage and Part D quality programs and a documented, quantifiable track record of moving clinical pharmacy Stars measures in a volatile cut point environment.
• Execution instinct. You are a relentless self-starter who refuses to let initiatives die in committee. You will roll up your sleeves to manipulate raw data, draft a workflow, or personally audit a vendor's call dispositions. You measure yourself on what shipped, not what was discussed. You thrive in environments where you need to move fast and adapt quickly.
• Insight generation. Advanced analytical acumen and the ability to see past the surface of a dashboard to the root cause of non-adherence, then design the targeted, cost-effective intervention that addresses it. Comfort with business intelligence tooling and with sizing an opportunity before committing resources to it.
• Demonstrated leadership impact and collaborative excellence, with experience successfully influencing outcomes across organizational levels, whether through direct management, cross-functional project leadership, or matrix reporting relationships that require building consensus without formal authority. You are energized by working with diverse backgrounds, and deeply motivated by helping our front line teams do their best work and members achieve their best, healthiest lives.
• Clinical diplomacy. You can hold a nuanced clinical conversation with a skeptical clinical leader, earn their respect, and change prescribing behavior without authority over them.

Nice To Haves

• Motivated by learning quickly in complex clinical and operational domains. You read the source material yourself and are excited to catch everyone up.
• AI explorations. Curiosity about emerging technologies and a pragmatic approach to using them. Experience using LLMs to build complex prompts and tools is a strong plus.
• Skill and rigor in using and analyzing data. You understand the pitfalls of metrics (e.g., how open vs. closed periods affect data, or how denominators shift over time). You are comfortable thinking in ranges and probabilities rather than false precision, and you can distinguish between a metric changing and the underlying reality changing.

Responsibilities

• Own the performance trajectory of the full clinical pharmacy Star portfolio, including the triple-weighted medication adherence measures (Diabetes, RAS Antagonists, Statins), Statin Use in Persons with Diabetes (SUPD), Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH), and Concurrent Use of Opioids and Benzodiazepines (COB). Forecast measure trajectories against projected cut points, identify risk months before it shows up in a year-end score, and translate the analysis into daily, weekly, and monthly operating directives that internal teams and vendors can actually execute against.
• Serve as the authoritative clinical voice on pharmacy quality. Track regulatory specification changes and clinical guideline shifts and interpret what they mean for our operations. Lead peer-to-peer dialogue with clinical leaders within Devoted and our growing provider network.
• Keep us ahead of the measure set rather than reacting to it. Track what CMS is developing, what sits on the display page, and what the measure developer pipeline is producing. Build the data and operational capability for a measure while it's still on display, so that when it enters Stars we are already performing instead of standing up a workflow. Own the read on every Advance Notice, Proposed Rule, and Final Rule, translate them into what specifically changes for Devoted, and bring us a point of view.
• Design organization-wide strategies across the portfolio of clinical pharmacy measures to deliver 5-Star performance at scale. You will identify innovative opportunities to eliminate friction points along members’ healthcare journeys, empowering them to achieve their healthiest lives.
• Manage performance against operating KPIs and clinical outcomes metrics by partnering with internal Devoted teams and external partners, including our PBM, to design and implement solutions that improve clinical and care coordination interventions. You will translate goals into actionable strategies and guide initiatives from pilot phase through full-scale implementation across our member population as well as our provider and pharmacy networks.
• Keep a pulse on the vendor landscape: who is doing credible work in adherence stratification, pharmacist-led intervention, and pharmacy network engagement, what those platforms actually deliver versus what the sales deck promises, and whether there's a case for bringing one in. We build rather than buy by default. We expect you to have an informed opinion on when that calculus should change, and to be able to defend it either way.
• Drive execution through a blend of direct management and leadership through influence, operating with a true servant-leader mindset that prioritizes enabling, unblocking, and supporting teams. You will translate complex operational goals into daily workflows that set our teams - and our members - up for success.

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program

What This Job Offers

• Job Type: Full-time
• Career Level: Director