Director, Pharmacy Quality & Part D Stars (Finance)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Director, Pharmacy Quality and Part D Stars is a key leader within the Pharmacy Department, supporting the MAPD plan's efforts to advance Part D Star Ratings and pharmacy quality measures that drive member outcomes.

The Director will design and lead targeted pharmacy initiatives to advance Stars performance, oversee PBM and vendor performance, and ensure alignment with organizational goals. Success in this role will be defined by the ability to drive cross-functional collaboration and deliver measurable improvements in pharmacy quality outcomes and member experience.

Job Duties/Responsibilities:

Create and implement a multi-year pharmacy Stars and quality roadmap, aligned with CMS methodology and enterprise Stars goals.

Monitor CMS methodology updates, assess their impact on pharmacy measures, and integrate changes into Stars strategies and operations.

Anticipate emerging trends and proactively adjust strategies to maintain and enhance pharmacy S TAR s performance.

Lead the development and execution of pharmacy-driven strategies to improve Stars measures and quality outcomes, including medication safety, adherence, MTM, SUPD, SPC, and member experience.

Monitor current performance and evaluate interventions, with added focus on areas of greatest opportunity or risk.

Lead both internal pharmacy programs and PBM/vendor partnerships to ensure high performance and accountability across all Stars-related measures.

Represent Pharmacy in PBM, vendor, and cross-functional forums, ensuring strategies are aligned and Stars performance expectations are achieved.

Build and deliver dashboards, forecasts, and executive reports that translate complex data into actionable insights and recommendations, highlighting risks and guiding Stars performance decisions.

Lead, mentor, and develop a high - p erforming team, fostering a culture of accountability, innovation, continuous improvement, and optimized workflows that support Stars performance.

Job Requirements:

Experience:

• Required: 7+ years of experience in Medicare Part D, S tar s , or pharmacy quality, including at least 5 years in leadership roles.

Education:

• Required: Bachelor's degree required

• Preferred: A dvanced degree preferred (PharmD, RN, MPH, MBA, or related field)

Specialized Skills:

• Required:

• Demonstrated success improving CMS Star Ratings through pharmacy-driven initiatives and PBM/vendor collaboration.

• Deep knowledge of CMS Part D Stars methodology , pharmacy quality measures, and regulatory updates that impact performance.

• Expertise in leveraging data analytics to guide forecasting, strategy, and decision-making.

• Proven ability to lead teams, align cross-functional efforts, and communicate effectively with senior leadership.

• Proven ability to anticipate trends, adapt strategies, and deliver measurable improvements in Stars performance and member outcomes.

• Ability to communicate positively , professionally and effectively with others ; provide leadership , teach and collaborate with others .

• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution .

• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Essential Physical Functions :

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 accommodation may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear . The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $149,882.00 - $224,823.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

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