Quality Improvement - Clinical Pharmacist - CMS STARS & Population Health 195-2018

JOB SUMMARY:

The Clinical Pharmacist in the Quality Improvement Department plays a pivotal role in advancing the health plan's performance in CMS Star Ratings (Part D) and Population Health initiatives. This position is responsible for developing, implementing, and evaluating pharmacy-related quality improvement strategies that enhance medication adherence, optimize therapeutic outcomes, and improve member health outcomes across diverse populations.

KEY RESPONSIBILITIES:

• Lead and support initiatives to improve Part D measures. Analyze prescription drug performance data and identify trends, gaps, and opportunities for improvement.
• Collaborate with internal and external teams and PBM to implement targeted interventions and outreach strategies.
• Monitor CMS technical specifications and ensure compliance with regulatory updates.
• Completes education for members and providers, including, but not limited to, alternative medication therapies for all medications where clinically appropriate, high-risk medications for polypharmacy, patient assistance programs, and protocols for statin rechallenge.
• Design and execute clinical programs that address medication-related gaps in care.
• Support disease management programs through evidence-based medication therapy recommendations.
• Engage with health system leaders, providers, care managers, and members to promote safe and effective medication use.
• Collaborate and execute clinical initiatives for Part-D PBM programs.
• Develop, implement, and oversee the execution of pharmacologic protocols and interventions that improve quality and value to members and providers.
• Utilize pharmacy claims, HEDIS, and Stars data to drive decision-making.
• Develop dashboards, reports, and presentations for internal and external stakeholders.
• Participate in quality committees and cross-functional workgroups.
• Provide clinical education to providers, pharmacists, and care teams.
• Design and disseminate provider-facing educational materials to support CMS Stars polypharmacy quality measures (e.g., Poly-ACH and COB), promoting evidence-based alternatives for prescribing strategies to optimize medication regimens and improve patient outcomes. Develops member-facing materials to support medication adherence and chronic disease management.
• Represent the health plan at community events, provider meetings, and industry conferences.
• Supervises other team members, including both clinical and non-clinical personnel, in program operation and implementation.
• Perform other duties as assigned.

QUALIFICATIONS:

• Geriatric specialty or certification a plus, Geriatric Pharmacy (BCGP).
• Strong analytical and data interpretation skills.
• Proficiency in Microsoft Office, specifically Excel and Power BI, data visualization tools, and pharmacy claims platforms.
• Excellent communication, collaboration, and project management abilities.
• Board Certification (e.g., BCPS, BCACP) preferred.
• Familiarity with HEDIS, NCQA, and Medicare regulations preferred.
• Successful completion of Health Care Sanctions background check.

EDUCATION/EXPERIENCE:

• Doctor of Pharmacy (PharmD) required from an accredited school of pharmacy; residency training (PGY1 or PGY2) preferred.
• Active and unrestricted pharmacist license by the Oklahoma State Board of Pharmacy.
• Minimum 3 years of clinical pharmacy experience, preferably in managed care, health plan, or quality improvement settings.
• Experience with CMS Star Ratings, MTM programs, and population health strategies.
• Experience with health equity and culturally competent care initiatives preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin