Clinical Operations Manager
Sunday Health
Clinical Pharmacy Director, Part D Stars
Lumeris
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Serve as a Part D Stars subject matter expert - provide clinical guidance and recommendations to enhance member outcomes, medication adherence, and overall health plan performance related to Part D Star measures
- Develop, recommend and implement Part D Stars operational strategy and roadmap
- Analyze, interpret, and enhance Part D Stars data and other pharmacy utilization reporting to identify areas for improvement and develop action plans to drive performance improvement
- Develop provider focused education and best practice content to be used in external partner meetings that drive improvement in Part D Stars and pharmacotherapy utilization optimization which supports safe and effective medication use
- Collaborate with cross-functional teams, including but not limited to provider services, quality, data analytics, pharmacy operations to ensure alignment and execution of Part D Star improvement initiatives
- Participate in oversight of Part D Stars vendors and identify new partnership opportunities
- Clearly articulate progress, achievements, and opportunities related to Part D Star measures to key stakeholders
- Assists in the development and review of pharmacy utilization reports targeted at physician group level and physician-specific level. Makes recommendations on ways to optimize pharmacotherapy utilization
- Trains pharmacy team members and other internal stake holders on Part D Star measures, initiatives, best practices and how to leverage target reporting to engage provider group partners.
- Guides and mentors team members to achieve departmental and company goals
- Collaborate closely with the VP, Clinical Pharmacy and Director, Pharmacy Operations to oversee and execute all pharmacy operations pertinent to Part D Stars and pharmacy benefit optimization
- Stay abreast of industry trends, regulatory changes, and best practices related to Part D Star measures and quality improvement
- Performs special projects as assigned
Requirements
- Doctor of Pharmacy (PharmD) with a valid, registered pharmacy license in good standing
- Five (5) or more years of Managed Care experience or relevant clinical experience or the knowledge, skills, and abilities to succeed in the role
- Three (3) or more years of Medicare Advantage HEDIS/Stars experience
- Board certification in one or more of these areas of focus: Board Certified Pharmacotherapy Specialist (BCPS), Board Certified Ambulatory Care Pharmacist (BCACP) and/or Board-Certified Geriatric Pharmacist (BCGP)
- Experienced in leading projects that consistently achieve desired results with the ability to organize, prioritize, multi-task, and delegate tasks effectively
- Demonstrated ability to communicate effectively with diverse stakeholders and collaborate cross functionally
- Proactively identifies opportunities for improvement and takes ownership of solutions
- Adept at tailoring complex medication information from various sources (ie: prescription, OTC, herbal) to patients and other healthcare professionals in a clear, concise, and accessible manner
- Coached and mentored team members to enhance their skills and performance
- Creative thinker with strong judgment and motivation to problem solve
- Self-starter, possessing willingness and ambition to work through ambiguity
- Experienced in managing, analyzing and interpreting data sets with the ability to articulate actionable recommendations based on findings
- Strong computer skills including Microsoft Office
- Gifted public speaker and polished presentation style
- Preferred Clinical experience in ambulatory care
- Completion of an ASHP Accredited PGY-1 Pharmacy Residency
- Experience using Electronic Medical Records (EMR), such as EPIC or AllScripts
