Manager of Part D Stars and Quality

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor of Science in Pharmacy OR Doctor of Pharmacy (Pharm.D.) from an ACPE accredited school of pharmacy.

2. Must possess current license to practice pharmacy in West Virginia or be license eligible. Licensure must be completed within 90 days of hire. If licensure is not obtained within 90 days of start date, associate will be notified that they will be released from their employment.

EXPERIENCE:

1. Five (5) years of Managed Care experience.

2. Three (3) years of Medicare Advantage HEDIS/Stars experience.

3. Three (3) years' experience working in a clinical pharmacy practice.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Managed Care Residency OR Board Certified Pharmacotherapy Specialist, Board Certified Ambulatory Care Pharmacist, and/or Board Certified Geriatric Pharmacist.

2. Experience in Medication Therapy Management, proficiency in utilizing MTM platforms and tools.

3. Experience utilizing Electronic Medical Records, such as EPIC.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Develops, recommends, and implements Peak Advantage Part D Stars operational strategy and roadmap.

2. Manages Peak Advantage's performance for all Part D medication adherence measures

3. Partner with clinical leaders across Peak Advantage to develop, implement, and execute successful medication adherence initiatives.

4. Establishes the goals, metrics, and ongoing strategy to support a successful initiative to ensure members remain adherent to maintenance medication therapies.

5. Act as the interdepartmental subject matter expert on quality initiatives, HEDIS, and Stars for pharmacy measures.

6. Evaluate, assess, and report on HEDIS/Stars performance for the health plan.

7. Identifies and implements innovative strategies to impact health plan's quality performance, clinical goals, and overall outcomes.

8. Prepare and provide reporting/presentations on overall health plan quality measure performance to leadership.

9. Collaborate with internal departments to educate on quality measures, health plan quality performance, and alignment of clinical and operational departmental goals. Provide regular feedback to ensure compliance with regulatory standards.

10. Participate in relevant boards, task forces, committees, meetings, and other activities.

11. Manages vendor relationships related to Part D Stars measure performance to ensure they are meeting contractual obligations and expectations.

12. Provides patient-centered care that will improve clinical outcomes and reduce total cost of care.

13. Maintain knowledge of chronic disease states such as but not limited to diabetes, heart failure, COPD, asthma, cardiovascular disease, hypertension, dyslipidemia, anxiety, depression, bipolar disorders, and thought disorder. Remain current with clinical practice guidelines.

14. Ensures the safe, effective, appropriate, and cost-efficient management of medication therapy for plan beneficiaries, conducting comprehensive medication reviews, medication adherence outreach, and other outreach as appropriate to ensure the highest quality of patient care.

15. Follow up with clinics, providers, pharmacies, and health plan beneficiaries to resolve issues and concerns promptly.

16. Communicates individualized care plans effectively with beneficiaries, healthcare providers, and other members of the care team.

17. Foster ongoing relationships with providers, members, and various internal departments to ensure members are getting appropriate care.

18. Document and record services/activities in appropriate databases/software to ensure compliance with CMS regulations.

19. Supports basic data analytic activities and tracking of interventions and assists with preparation and documentation of responses to regulatory audits.

20. Develop training materials for the growing quality team and assist in the development of shared learning programs within our organization.

21. Make and document member/provider outreach interventions to close Part D Star measure open gaps.

22. Refer members as appropriate to Peak Health Plan and/or WVU programs for coordination of care.

23. Executes a performance management framework that enables sustainable and efficient operations.

24. This position may be required to obtain multi-state licensure as necessary for business need.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to stand and walk short distances for eight or more hours.

2. Frequent bending, stooping, or stretching.

3. Ability to lift 30 pounds and push 50 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Some travel may be required to provider offices and offsite meetings.

SKILLS AND ABILITIES:

1. Ability to work under stressful working conditions.

2. Ability to handle and maintain confidential information.

3. Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills.

4. Ability to work in a fast-paced and rapidly changing environment with attention to detail.

5. Ability to work proactively and independently to research and resolve complex issues.

6. Experience with regulatory and accreditation standards.

7. Ability to apply relevant laws, regulations, requirements, and policy standards.

8. Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms.

Additional Job Description:

Scheduled Weekly Hours:

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