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Clinical Program Lead- Stars Pharmacy Quality

Job Description

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.

Job Requirements

Responsibilities



  • 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



Required Qualifications



  • 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


Preferred Qualifications



  • Accredited Pharmacy Residency or equivalent experience a plus

  • Previous Health Plan and or Medicare/Medicaid Experience a plus

  • English/Spanish Bilingual is a plus


Additional Information



  • 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

  • Attachments

  • Understand quality measures and how it impacts the health plan


Scheduled Weekly Hours
40

Job Snapshot

Location US-VA-Virginia Beach
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Health Care, Insurance
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Company Overview

Humana

Throughout our 50-year history, Humana has always been one step ahead, constantly evolving with the changing world of healthcare. It is our proactive, forward-thinking approach that has allowed us to not only meet the needs of our customers, but also provide a challenging and exciting work experience for our associates.

Contact Information

US-VA-Virginia Beach

Snapshot
Humana
Company:
US-VA-Virginia Beach
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care, Insurance
Store Type:

Job Description

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.

Job Requirements

Responsibilities



  • 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



Required Qualifications



  • 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


Preferred Qualifications



  • Accredited Pharmacy Residency or equivalent experience a plus

  • Previous Health Plan and or Medicare/Medicaid Experience a plus

  • English/Spanish Bilingual is a plus


Additional Information



  • 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

  • Attachments

  • Understand quality measures and how it impacts the health plan


Scheduled Weekly Hours
40

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Clinical Program Lead- Stars Pharmacy Quality Apply now