Gerente de Intervencion De Estrellas En Farmacia
Regular
Exempt
GENERAL DESCRIPTION:
Responsible for overseeing all Stars measures and working closely with the company management and key stakeholders to achieve and sustain a higher performance in the Center for Medicare and Medicaid Services (CMS) Medicare Pharmacy Star ratings for measuring the quality of health and drug services received. Track results against goals in pharmacy performance and display measures to ensure the attainment of department Star goals. Develop initiatives to improve the results achieved in the measures. Analyzes the results of the strategies implemented to improve the measures.
ESSENTIAL FUNCTIONS:
- Oversee stakeholder performance goals and ensure accountability for achieving Medicare Stars performance improvements.
- Develop and manage comprehensive Stars program activities, including schedules, milestones, resources, scope, and issue resolution, ensuring timely completion and regular progress reporting to executive sponsors and key stakeholders.
- Collaborate with key stakeholders to develop and implement action plans that address new CMS Medicare Star program requirements.
- Evaluate the effectiveness and outcomes of implemented initiatives, identify performance gaps, and implement corrective actions to enhance results.
- Conduct detailed data analysis, maintain dashboards, track trends, and establish metrics to measure progress toward Medicare Stars goals.
- Identify significant issues and root causes impacting health plan performance and provide leadership with data-driven recommendations and mitigation strategies.
- Conduct market and industry research on Stars measures, benchmarking internal initiatives against CMS requirements and external standards, providing actionable insights to support operational decisions.
- Act as a liaison within the Pharmacy Department, leading Star-related program development and coordinating with external partners as necessary.
- Create and deliver high-quality presentations and communication materials for leadership and management, incorporating data analysis, graphics, and infographics.
- Conduct outreach to members, pharmacies, and providers to address quality-of-care gaps, identify root causes, and ensure timely closure of action items.
- Support initiatives involving troubleshooting, issue tracking, system configuration, vendor management, and other Stars-related initiatives.
- Respond to pharmacy-related inquiries from members and internal staff, escalating complex concerns promptly to appropriate parties.
- Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
- Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
- May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience: Bachelor’s Degree in Business Administration, Public Health Major in Health Services Management, or related fields. At least five (5) years of experience in data analysis, program management, and reporting within healthcare or insurance, including pharmacy operations and managed care, with direct involvement in Medicare Stars or similar quality improvement programs in the Healthcare industry. At least two (2) years of experience supervising personnel.
“Proven experience may be replaced by previously established requirements.”
Certifications / Licenses: Not required. Other: Strong knowledge of the Medicare Stars program, CMS regulations, and quality measurement methodologies. Familiarity with pharmacy benefit management and healthcare quality improvement processes.
Languages:
Spanish – Advanced (comprehensive, writing, and verbal)
English – Advanced (comprehensive, writing, and verbal)
“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”
