Director, Clinical Pharmacy Stars Performance

Job Description

Director, Clinical Pharmacy Stars Performance

A bit about this role:

As Director, Clinical Pharmacy Stars Performance, you are the tactical owner of every clinical pharmacy-related measure in our Medicare Advantage and Part D Star Ratings portfolio. Your job is to drive our clinical pharmacy Stars enterprise strategy into daily reality, measure by measure, member by member, week by week. This is the most consequential set of measures we own.

You will be the enterprise clinical subject matter expert on pharmacy quality: the person Medical Directors call before they call anyone else, the person who reads the Technical Notes the day they drop, and the person who can tell us in February where a cut point is going to land in October and what we need to do about it now. You will also be the person building the tracker, setting the objectives and key results, and personally auditing whether the outreach was actually effective.

You will report directly to the AVP, Pharmacy, carrying the portfolio into executive meetings, leading cross-functional escalations, and owning outcomes.

Responsibilities and Impact will include:

• Performance Management & Insight Generation. Own the performance trajectory of the full clinical pharmacy Star portfolio, including the triple-weighted medication adherence measures (Diabetes, RAS Antagonists, Statins), Statin Use in Persons with Diabetes (SUPD), Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH), and Concurrent Use of Opioids and Benzodiazepines (COB). Forecast measure trajectories against projected cut points, identify risk months before it shows up in a year-end score, and translate the analysis into daily, weekly, and monthly operating directives that internal teams and vendors can actually execute against.

• Clinical Subject Matter Expertise & Clinical Collaboration. Serve as the authoritative clinical voice on pharmacy quality. Track regulatory specification changes and clinical guideline shifts and interpret what they mean for our operations. Lead peer-to-peer dialogue with clinical leaders within Devoted and our growing provider network.

• Future Measure Readiness. Keep us ahead of the measure set rather than reacting to it. Track what CMS is developing, what sits on the display page, and what the measure developer pipeline is producing. Build the data and operational capability for a measure while it's still on display, so that when it enters Stars we are already performing instead of standing up a workflow. Own the read on every Advance Notice, Proposed Rule, and Final Rule, translate them into what specifically changes for Devoted, and bring us a point of view.

• Strategy & Innovation. Design organization-wide strategies across the portfolio of clinical pharmacy measures to deliver 5-Star performance at scale. You will identify innovative opportunities to eliminate friction points along members’ healthcare journeys, empowering them to achieve their healthiest lives.

• Excellent Cross-Functional Execution. Manage performance against operating KPIs and clinical outcomes metrics by partnering with internal Devoted teams and external partners, including our PBM, to design and implement solutions that improve clinical and care coordination interventions. You will translate goals into actionable strategies and guide initiatives from pilot phase through full-scale implementation across our member population as well as our provider and pharmacy networks.

• Market Awareness. Keep a pulse on the vendor landscape: who is doing credible work in adherence stratification, pharmacist-led intervention, and pharmacy network engagement, what those platforms actually deliver versus what the sales deck promises, and whether there's a case for bringing one in. We build rather than buy by default. We expect you to have an informed opinion on when that calculus should change, and to be able to defend it either way.

• Servant Leadership. Drive execution through a blend of direct management and leadership through influence, operating with a true servant-leader mindset that prioritizes enabling, unblocking, and supporting teams. You will translate complex operational goals into daily workflows that set our teams - and our members - up for success.

Required skills and experience:

• PharmD or equivalent clinical degree. The role demands clinical credibility and independent clinical judgment on complex medication management strategies.

• 7+ years of progressive leadership in managed care, a health plan, or a PBM, with dedicated ownership of Medicare Advantage and Part D quality programs and a documented, quantifiable track record of moving clinical pharmacy Stars measures in a volatile cut point environment.

• Execution instinct. You are a relentless self-starter who refuses to let initiatives die in committee. You will roll up your sleeves to manipulate raw data, draft a workflow, or personally audit a vendor's call dispositions. You measure yourself on what shipped, not what was discussed. You thrive in environments where you need to move fast and adapt quickly.

• Insight generation. Advanced analytical acumen and the ability to see past the surface of a dashboard to the root cause of non-adherence, then design the targeted, cost-effective intervention that addresses it. Comfort with business intelligence tooling and with sizing an opportunity before committing resources to it.

• Demonstrated leadership impact and collaborative excellence, with experience successfully influencing outcomes across organizational levels, whether through direct management, cross-functional project leadership, or matrix reporting relationships that require building consensus without formal authority. You are energized by working with diverse backgrounds, and deeply motivated by helping our front line teams do their best work and members achieve their best, healthiest lives.

• Clinical diplomacy. You can hold a nuanced clinical conversation with a skeptical clinical leader, earn their respect, and change prescribing behavior without authority over them.

Desired skills and experience:

• Motivated by learning quickly in complex clinical and operational domains. You read the source material yourself and are excited to catch everyone up.

• AI explorations. Curiosity about emerging technologies and a pragmatic approach to using them. Experience using LLMs to build complex prompts and tools is a strong plus.

• Skill and rigor in using and analyzing data. You understand the pitfalls of metrics (e.g., how open vs. closed periods affect data, or how denominators shift over time). You are comfortable thinking in ranges and probabilities rather than false precision, and you can distinguish between a metric changing and the underlying reality changing.

Salary Range: $182,000 - $247,000 a year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Originally posted on Himalayas