Director, Pharmacy Part D Stars

Alignment Health

1d•Remote

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Director, Part D Stars is a key leader with direct accountability for Part D Star Ratings performance. This position owns the end to end execution, measurement, and continuous improvement of Part D Stars programs operated within the organization. This is a hands on leadership role suited for an experienced Part D Stars leader who has personally driven results through operational execution and deep measure expertise — not solely through vendor oversight or enterprise level governance. Success is defined by the ability to translate Part D Stars requirements into operational programs, reporting, and measurable results delivered by internal teams, while championing cross functional collaboration and organizational alignment. This position is remote. Must be available to take meetings during PST hours.

Requirements

7+ years of experience in Medicare Part D, Stars, or pharmacy quality management
Minimum 5 years in a leadership role within a health plan, PBM, or IPA
Demonstrated success improving CMS Star Ratings through pharmacy-driven initiatives, cross-functional collaboration, and PBM/vendor engagement
Demonstrated expertise interpreting Part D Stars technical specifications and translating them into business logic and metrics
Proven experience using data analytics to drive performance forecasting, Stars strategy, and operational decision-making
CMS Part D Stars & Regulatory Knowledge (Advanced): Deep, current knowledge of CMS Part D Star Ratings methodology, pharmacy quality measures, technical specifications, and regulatory change cycles that affect plan performance.
Data Analytics & Performance Reporting (Advanced): Proficiency in leveraging healthcare data to build forecasting models, performance dashboards, and executive reports. Ability to interpret complex statistical outputs and translate them into clear strategic recommendations.
PBM & Vendor Management (Advanced): Demonstrated ability to manage PBM relationships, navigate vendor contracts, and hold partners accountable to performance standards through governance structures and performance metrics.
Clinical Pharmacy Program Design (Intermediate–Advanced): Working knowledge of clinical pharmacy programs including MTM, medication adherence interventions, SUPD, and formulary-related quality measures. Experience evaluating program ROI and clinical effectiveness.
Cross-Functional Leadership & Stakeholder Influence (Advanced): Proven ability to align diverse teams and senior stakeholders around shared quality goals. Strong executive communication skills and comfort operating in matrixed, fast-paced healthcare organizations.
Strategic Planning & Change Management (Advanced): Ability to design multi-year roadmaps, anticipate regulatory disruption, and translate strategy into executable, measurable operational plans.
Analytical Reasoning & Problem-Solving (Advanced): Ability to use advanced reasoning to define complex problems, collect and interpret data, draw valid conclusions, and design and implement effective resolution strategies.
Bachelor's degree required; fields such as Pharmacy, Health Sciences, Nursing, Public Health, or Business Administration are relevant

Nice To Haves

Prior experience managing PBM contracts or overseeing vendor performance governance
Experience working within a high-growth or matrixed Medicare Advantage health plan environment
Experience managing call center operations
Background in MTM program design or formulary management
Advanced degree strongly preferred: PharmD, RN, MPH, MBA, or a related clinical or health administration field. A demonstrated track record of clinical expertise and increasing leadership responsibility may substitute for advanced degree requirements on a case-by-case basis.
Active and unrestricted Pharmacist license (RPh or PharmD) is strongly preferred for candidates with a pharmacy background
California licensure preferred for candidates in California-based markets

Responsibilities

Lead the execution of initiatives to improve Part D Stars measures, including medication adherence (PDC), medication safety (SUPD, Poly-ACH, COB), Medication Therapy Management (MTM/CMRs), and related member experience measures.
Develop and lead a multi‑year Part D Stars and quality roadmap aligned with CMS methodology, annual technical specifications, and enterprise Stars goals.
Monitor CMS methodology updates, assess operational and reporting impact, and integrate changes into Stars strategies and workflows.
Serve as a subject matter expert for Part D Stars measures and translate CMS methodology and specs into executable data logic and business rules, performance metrics, and operational requirements used to manage performance and forecast outcomes.
Review and validate external performance reporting and resolve discrepancies between reported results and internal performance tracking.
Develop and deliver dashboards, forecasts, and executive reporting that translate complex Stars data into actionable insights and recommendations.
Monitor measure‑level performance, identify areas of risk or opportunity, and adjust interventions based on data‑driven insights.
Provide leadership oversight for call center programs supporting Part D Stars performance, ensuring outcomes, effectiveness and quality.
Partner with internal stakeholders, external vendors, and provider groups, as applicable, to support alignment, execution, and accountability for Part D Stars performance.
Represent the organization in cross‑functional forums supporting Stars performance, quality improvement, and operational alignment.
Lead, mentor, and develop a high performing team, fostering a culture of accountability, innovation, and continuous improvement.
This role includes direct supervisory accountability for pharmacy quality professionals and/or program managers. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.