The RX Clinical Programs Pharmacy Lead integrates programs developed to improve overall health outcomes with a focus on prescription drugs. The RX Clinical Programs Pharmacy Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
Responsible for driving positive performance of the Stars Patient Safety and Drug Pricing measures by influencing both the strategy and execution of improvement opportunities
Develops programs and strategies designed to increase the plan quality for the following measures: Medication Adherence - Diabetes, Hypertension, and Cholesterol, MTM-CMR, Statin Use in People with Diabetes, MPF Price Accuracy, and Statin Therapy for Patients with Cardiovascular Disease)
Enhance market level collaboration and partnership through analysis of performance, opportunities, and regional differences to subsequently develop programs driving regional improvement
Monitor rate performance via pharmacy reporting tools, including Acumen/QV/Tableau, to distill real-time progress, directing partners to necessary mitigation plans in effort to drive toward Stars performance targets.
Develop innovative pilots in Part D space to improve quality performance in current and/or future Stars measures
Bachelor's degree and 8+ years of technical experience
2+ years of project leadership experience
Clear and active Pharmacist license in the state(s) in which you are required to practice
Possess the ability to be licensed in multiple states without restrictions
Prior demonstrated success working in Pharmacy Operations in a retail, hospital or clinical setting
Experience in Medication Therapy Management or equivalent
Accredited Pharmacy Residency or equivalent experience a plus
Previous Health Plan and or Medicare/Medicaid Experience a plus
English/Spanish Bilingual is a plus
Medicare Part D Stars experience
Managed care and/or community pharmacy experience (2+ years) or residency/fellowship
Ability to work in a team and independently to strategize, prioritize, organize, and execute initiatives effectively to achieve goals
Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business needs
Ability to manage multiple projects, requests and deadlines with attention to detail.
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
Prior experience in leading and managing programs
Understand quality measures and how it impacts the health plan
Scheduled Weekly Hours