Stars - Pharmacy Measures Consultant

Clover is reinventing health insurance by working to keep people healthier.

The Stars team at Clover collaborates with teams across the organization to ensure the Stars strategy is implemented, executed, and will lead to improved performance across all measures. Stars operations are a critical barometer of the company's health, indicating how well we're helping our members achieve better health outcomes and how well we're functioning as a business.

We're looking to hire a Stars, Pharmacy Measures Consultant to execute Stars initiatives strategies in partnership with leadership and key internal and external stakeholders. In this role you will develop a tangible operational work plan and calendar of initiatives as well as dive into root cause analyses to address and remove barriers to success. You will collaborate across multiple teams with the goal of improved performance in Medication Adherence Star Measures and Statin use in persons with Diabetes and Cardiovascular Disease. Through partnerships with key peers, you'll also ensure the organization is improving performance across Diabetes, Hypertension, and Hyperlipidemia medication adherence measures, along with the Medication Therapy Management measure. You will also be responsible for coordinating with other Stars Program Leads to measure company-wide Stars performance and communicating related progress, challenges, and resourcing needs.

As the Pharmacy Measures Consultant (Part D), you will:

• Serve as Clover's Part D Subject Matter Expert by developing a strong knowledge of industry best practices, CMS guidelines, and Stars generally.
• Develop and maintain the Star Ratings work plan for medication adherence. Ensure Stars technical guidance from CMS, PQA and internal teams are incorporated into the work plan.
• Drive day-to-day operations related to medication adherence and collaborate with Stars leadership on strategic initiatives. Establish key performance indicators and metric level goals for medication adherence per contract.
• Build and manage dashboards that monitor and report on performance of initiatives and performance in Part D.
• Integrate analytics to inform and report on the status of initiatives. Evaluate effectiveness on impacting Star Rating and identify and prioritize actions needed to improve performance.
• Manage vendor/partner relationships for various Part D initiatives, including coordinating with our PBM.
• Collaborate internally to ensure medication adherence measures achieve established metric goals per contract.
• Report performance to plan leaders, and escalate issues and barriers to leadership.
• Train and mentor team members who assist with Part D administration.
• Contribute to projects aimed at improving Medicare Part C & D Stars Rating quality initiatives, HEDIS, CAHPS, and other quality metrics.
• Identify opportunities within Clover for integration of quality measures in current case management or other clinical programs.

You will love this job if:

• You love providing guidance and leadership to multidisciplinary project teams to deliver high quality, improvement-oriented analysis.
• You are tech and data savvy. You are used to thinking about how technology can enable better experiences and how you can use data to make better decisions.
• You know how to drive results.
• You value high trust, high ethics relationships and build/support these qualities in your working partners.
• You have and value in others strong, collaborative problem-solving skills.
• You are a seasoned critical thinker.

You should get in touch if:

• You have a strategic understanding of Medicare Advantage plan operations along with 5+ years successful business leadership experience in managed care with a focus on Part D Stars.
• You have 8+ years of qualitative and quantitative analytics experience with expertise in Excel / Google Sheets and building out of operational models.
• You have a holistic understanding of Medicare Stars strategy and experience working on related programs.
• You have experience and proficiency in project management, program evaluation, analysis, and consulting skills.
• You have a background as a Pharmacist or Pharmacy Tech (preferred).

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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover's inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one's identity. All of our employee's points of view are key to our success, and inclusion is everyone's responsibility.