Director Clinical Pharmacy Strategies - Medicare Star Strategy and Execution

Elevance Health•Mason, OH

6d•Hybrid

About The Position

The Director Clinical Pharmacy Strategies leads a Medicare Clinical team in developing, implementing, and evaluating Medicare CMS Star and CAHPS clinical interventions and cost-of-care management strategies for Medicare business segments. The role oversees Medicare CMS Star management initiatives and processes that affect healthcare quality, cost of care, and outcomes across retail and medical benefits. It also oversees the pharmacy CMS Star portfolio, including enterprise- and contract-level strategy execution and performance, while maintaining compliance with applicable regulations and guidance. The position supports Elevance Health contracts in pursuing four-star performance and works across clinical, quality, pharmacy, operations, analytics, and executive teams. It also contributes to business growth and client retention through proposal support, budget management, and clinical product revenue growth. The role hires, trains, coaches, counsels, and evaluates direct reports. The role is hybrid and requires associates to be in-office three days per week. Candidates must reside within commuting distance of an office unless an accommodation is granted as required by law. The position is designated as first shift.

Requirements

PharmD, RPh, or MPh and at least five years of managed care experience, or an equivalent combination of education and experience.
Current unrestricted pharmacist license in applicable state(s).
Bachelor of Science in Pharmacy.

Nice To Haves

Demonstrated expertise in CMS Medicare Star Ratings measures, methodology, and strategies to improve quality and performance outcomes, including experience achieving four-star performance.
Experience establishing ongoing performance monitoring, conducting root-cause analysis, identifying performance gaps and improvement opportunities, and implementing data-driven interventions to improve quality, operational, and business outcomes.
Ability to manage vendor relationships, oversee contractual performance, drive accountability, and ensure program execution through quality assurance, closed-loop reviews, performance validation, and ongoing optimization.
Strong Excel proficiency, including data analysis, dashboard development, reporting, trend analysis, and performance tracking, with the ability to translate data into actionable recommendations and support business decisions.
MBA.
Ability to influence and collaborate across Quality, Pharmacy, Operations, Analytics, Clinical, and Executive Leadership teams, with strong communication, stakeholder management, accountability, flexibility, and problem-solving skills.
Knowledge of OIG, ERISA, HIPAA, and the regulatory environment, as well as DSM, HEDIS, Quality Improvement, and clinical intervention program development and oversight.
Program management experience leading complex cross-functional initiatives, driving execution, managing competing priorities, and delivering strategic objectives and key business and quality outcomes.

Responsibilities

Lead a team that establishes and executes Medicare CMS Star clinical intervention programs to achieve four-star ratings for Elevance Health contracts.
Serve as a subject matter expert in evaluating and implementing clinical quality and cost-of-care programs.
Manage predictive clinical and economic rule sets used in pharmacy member and provider communications.
Support sales, account management, and Elevance Health plans in achieving four-star ratings for individual contracts.
Collaborate with Care Management, HEDIS, and the Clinical Pharmacy Care Center to improve medication compliance and achieve corporate goals.
Provide Request for Proposal (RFP) support and assist with business growth and client retention.
Manage the budget and increase clinical product revenue.
Hire, train, coach, counsel, and evaluate the performance of direct reports.
Oversee Medicare CMS Star management initiatives and processes affecting healthcare quality, cost of care, and outcomes across retail and medical benefits.
Oversee the pharmacy CMS Star portfolio, including enterprise- and contract-level strategy execution and performance, while maintaining compliance with related regulations and guidance.