Job Description
USE YOUR STRENGTHS AS A MEDICARE PHARMACY STARS CONSULTANT AT WELLMARK!
ABOUT THE ROLE: The Medicare Pharmacy Stars Consultant will provide day-to-day management and oversight of Wellmark’s Medicare Advantage Part D Star Ratings strategy and initiatives. You will be working closely with the pharmacy benefit manager, network pharmacies, the Medicare Advantage team, Pharmacy team, and other internal and external stakeholders. You will strategically build partnerships with pharmacies to improve medication adherence and optimize medication use performance. You will use reporting and data analysis to measure and improve Medicare Stars ratings, quality and total cost of care, while leading improvement strategies across the Iowa and South Dakota pharmacy network. In addition, you will collaborate and consult with Medicare Stars & Risk Practice Consultants to identify and support the specific needs of the Medicare Advantage provider network through Part D patient safety measure data analysis.
ABOUT YOU: You are inquisitive and focused on making data-driven conclusions, decisions and recommendations to achieve business goals and build partnerships internally and externally. You have strong written and verbal communication skills that aid you in consulting, collaborating, influencing and effectively communicating complex concepts and recommendations to varied audiences. You are skilled in relationship building and consultation. You are excited by change and innovation, and thrive when you have a ‘seat at the table’ to influence the growth and development of a new team and program. You are a self-starter, detail-oriented and flexible to changing priorities to meet the needs of stakeholders. TOP CANDIDATES WILL HAVE MEDICARE PHARMACY AND/OR PHARMACY DATA ANALYSIS EXPERIENCE.
Qualifications
REQUIRED: • Bachelor's degree or direct and applicable work experience. • 3+ years of related healthcare industry experience that reflects analysis of health care quality data and network performance management. • Demonstrates the ability to think strategically to ensure program success. • Demonstrated experience influencing stakeholders. • Excellent analytical skills, data management capabilities, and strong attention to detail. Technical aptitude to learn new data management and analysis tools or methodologies quickly. • Effective consultation and critical thinking skills. Ability to review data and provide measurable outcomes and trend measures to support and influence business decisions. • Strong written and verbal communications skills with the ability to share technical insights and recommendations with varying stakeholder audiences, including pharmacists and external vendors. Adapts communication based on audience. • Self-starter able to produce quality results based off sound decision making skills. Effective time management with flexibility and adaptability to change. • Proficiency with the Microsoft Office Suite. • Ability to travel within the state of IA up to 25%, if needed.
PREFERRED: • 2+ years’ experience with Medicare Star Ratings. • Experience with quality improvement initiatives strongly preferred. • Experience with pharmacy network management strongly preferred.
Additional Information
a. Establish positive, long-term, consultative relationships with pharmacies.
b. Develop and implement Medicare Advantage pharmacy network strategies that support Star Rating quality measures and pharmacy incentive programs.
c. Analyze pharmacy quality program performance data and collaborate with internal and external stakeholders/vendors to identify and prioritize pharmacy outreach strategies to help achieve quality program targets with the goal to optimize medication use, maximize member and pharmacy experience, and Star measure outcomes.
d. Use data to determine and communicate organizational risk and impact of Part D Star measure performance gaps.
e. Develop comprehensive, pharmacy-specific plans to increase Stars and quality performance.
f. Provide value-added consulting, training, and coaching to assigned pharmacy organizations while focusing on the long-term goals of the pharmacies and Wellmark.
g. Lead pharmacy meetings to drive action plans, continual process improvement and achievement of performance goals.
h. Collaborate with Health & Pharmacy Services to implement and monitor the value-based pharmacy program for Wellmark Advantage Health Plan.
i. Advise Medicare Advantage leaders on Part D specific measure best practices and pharmacy incentives.
j. Other duties as assigned.
THIS JOB REQUIRES A NON-COMPETE AGREEMENT.
HYBRID WORK ENVIRONMENT: You will have the flexibility to work where you are most productive. As a hybrid employee, you’ll spend at least a day a week in the office – leaders and employees will work together on which day(s) they would like to work in the office and which days they prefer to work remotely. This may vary week-to-week based on meeting schedules and other business needs to optimize in-person collaboration.
AN EQUAL OPPORTUNITY EMPLOYER
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com