Reporting to the Vice President, Outpatient Pharmacy Services, the Senior Manager—Pharmacy Quality and Medicare Stars is responsible for:
- Developing and executing comprehensive strategy for the health plan's pharmacy-related quality measures and programs, including CMS Stars and HEDIS initiatives, ensuring alignment with organizational goals and regulatory requirements.
- Overseeing overall performance management and continuous improvement of pharmacy quality metrics, identifying opportunities for optimization and implementing evidence-based solutions to enhance member outcomes.
- Leading the development, implementation, and monitoring of Part D Stars programs and Medicare Advantage pharmacy initiatives, ensuring compliance with CMS requirements and maximizing performance scores.
- Managing Medication Therapy Management (MTM) programs and related pharmacy quality initiatives, including program design, member engagement strategies, and performance tracking.
- Engaging and collaborating with key stakeholders across the enterprise, including clinical teams, operations, finance, and external partners, to drive alignment and support successful program execution.
- Analyzing pharmacy quality data and performance metrics to identify trends, gaps, and improvement opportunities, presenting findings and recommendations to senior leadership.
- Managing relationships with pharmacy vendors and external partners, ensuring service delivery meets organizational standards and contractual obligations.
- Providing strategic guidance on regulatory changes, industry best practices, and emerging pharmacy quality trends to inform organizational decision-making.
- Overseeing budget management for pharmacy quality and Stars programs, ensuring efficient resource allocation and return on investment.
- Leading cross-functional teams and mentoring pharmacy staff on quality initiatives, program requirements, and performance expectations.
EDUCATION/EXPERIENCE REQUIRED:
- Doctor of Pharmacy (PharmD) degree required.
- Residency training preferred.
- Minimum of seven (7) years of professional experience with progressively more responsibility in an integrated health system and/or health plan and experience meeting the unique needs of various health plan populations including Medicare. Demonstrated experience leading Part D Stars, MTM Program, and pharmacy quality initiatives required. Vendor management experience preferred.
Exemplary oral and written communication skills as evidence by prior examples of effective implementation of strategies with a variety of system personnel and patients.
CERTIFICATIONS/LICENSURES REQUIRED: Licensed to practice pharmacy in the State of Michigan.
