Lead strategy, execution, and performance management for Medicare Part D Stars. Drive analytics, reporting, forecasting, and cross-functional initiatives to achieve 4+ Star performance. Manage and develop the Quality & Stars team, partner with PBMs, pharmacy operations, product, and compliance, and translate CMS requirements into operational plans and improvement actions.
Job Description
We're seeking a Director, Part D Stars Strategy to join our Government Pharmacy Programs Department. The Director, Part D Stars Strategy, is responsible for driving the day to day strategy, execution, and performance management of Medicare Part D Star Ratings. This role serves as the operational and analytical lead for Part D Stars, translating CMS requirements and performance insights into actionable improvement initiatives that support the organization’s goal of achieving and sustaining 4+ Star performance.You will partner closely with Pharmacy Operations, Analytics, PBM Partners, Product, and Stars team, and plays a critical role in enabling informed decision making through data analytics, forecasting, segmentation, and program oversight. The Director will also lead our internal Quality & Stars team, overseeing team performance, professional development, progress against goals, and ensuring attainment of Part D Stars targets.
What You'll Do
Part D Stars Strategy & Execution
- Lead the execution of the Medicare Part D Stars strategy in alignment with organizational goals and CMS technical specifications.
- Accountable for performance management of Part D Stars measures, including adherence, medication safety, MTM, pharmacy quality measures, and leading indicators/KPIs.
- Lead, develop, coach and mentor internal Part D Quality & Stars team to achieve enterprise Part D Stars targets.
- Assess Part D Stars outsourcing opportunities to improve performance as needed.
- Translate annual CMS updates into operational plans and performance targets.
- Support multi‑year improvement planning and monitor progress against Stars goals.
Analytics, Reporting & Forecasting
- Direct development and maintenance of Stars performance dashboards and reporting for leadership and operational teams.
- Partner with Stars and analytics teams to develop forecasting models, test & learn scenarios, member & provider segmentation, Stars cut point scenarios, and risk assessments.
- Monitor measure trends and identify emerging risks or improvement opportunities.
Cross‑Functional Collaboration
- Collaborate with pharmacy operations, PBM partners, clinical programs, Stars and Product teams, and vendors to implement Stars improvement initiatives.
- Partner with compliance and regulatory teams to support audit readiness and CMS inquiries.
- Serve as a trusted advisor to leaders by clearly communicating performance insights and recommended actions.
What You Bring
- Bachelor's degree or advanced degree (where required)
- 8+ years of experience in related field.
- In lieu of degree, 10+ years of experience in related field.
Bonus Points(Preferred Qualifications)
- Master’s degree in Public Health, Pharmacy, Analytics, Business, or a related field preferred.
- 5–8 years of experience in Medicare Part D Stars, pharmacy quality, PBM operations, or health plan analytics.
- Strong working knowledge of Medicare Part D Stars measures, methodology, and CMS technical specifications.
- PharmD, MPH, MS in Analytics, or similar advanced degree.
- Experience with MTM programs, adherence interventions, and pharmacy operations.
- Experience with pharmacy related CAHPS measures and how to drive customer experience improvements to positively impact CAHPS.
- Familiarity with CMS systems and regulatory submissions (e.g., HPMS).
- Experience using tools such as Power BI or Tableau.
- Demonstrated success managing complex, cross‑functional teams.
- Strong analytical and problem‑solving skills with experience interpreting performance data and forecasts.
- Effective written and verbal communication skills, including experience presenting to senior leaders.
What You'll Get
- The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
- Work-life balance, flexibility, and the autonomy to do great work
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
- Learn more
Where You’ll Work
- Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.
- In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection.
- In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.
- Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting(Onsite expectations will be discussed during the interview process).
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Clinical Process Improvement, Healthcare Management, Managed Care, Medicare Regulations, Medication Management, Pharmaceutical Industry, Pharmacy, Pharmacy Benefits Management (PBM), Pharmacy Compliance, Pharmacy Management, Pharmacy Operations, Policy Development, Quality Care, Quality Management, Regulatory Compliance, Specialty Pharmacies_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].
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