Job Description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Senior Director Star Ratings & Quality Center of Excellence - RemoteThe Government Programs Senior Director Star Rating and Quality Center of Excellence (COE) is responsible for leading strategy development and executing all services and programs designed to improve key quality related measurements for Medicare and Managed Medicaid. This role leads a Star and quality team in identifying and developing core tools, resources, and technology to drive Star Ratings performance and quality metrics. Leads Center of Excellence workgroup to collaborate with key internal and external partners and vendors to create innovative offerings to drive Medicare Star Ratings that earn clients’ Medicare Advantage quality bonus payments, increase affordability / reduce the total cost of care for members and clients, and enables membership growth for our clients.

Responsibilities

• Formulate strategic and tactical plans, processes, and tools relative to the highest standards of quality; establish and maintain quality procedures and processes that drive Star ratings and measurable results.
• Develop a comprehensive Medicare Star Ratings and CAHPS strategy that meets the needs of clients to attract and retain members and achieve quality bonus payments.
• Lead cross-functional Star / Quality COE workgroup and steering committee with key internal partners such as clinical programs, member experience, and data/analytic to drive synergies related to quality improvement and new product / program development for Prime’s Government Programs book of business. Provide strategic consultation and solutions to our clients that delivers on client’s strategic objectives.
• Lead team of quality managers and data analysts, to provide work direction, budget, performance and development, resource planning, and consistently demonstrate Prime’s leadership expectations during interactions with direct reports, cross-functional and external stakeholders.
• In partnership with Compliance and Government Affairs, ensure proactive monitoring/tracking, review, and response to proposed regulatory policy and contract obligations as applicable to Medicare Star Ratings and other quality program changes. Interact with key industry quality leaders and position Prime as a leader in this space through measurable and sustained year over year results / improvement.
• Develop, implement, manage, and maintain tools, technology, and processes to support Star rating and quality performance.
• Lead competitive market analysis and identify new trends and opportunities to inform Star rating and quality strategy and position Prime for growth.
• Participate in GP Strategy and other workgroups to integrate quality / Medicare Star Ratings lens into our daily work looking for ways to drive efficiency, improve processes, and enhance member experience in alignment with the Centers for Medicare & Medicaid Services (CMS) program requirements.
• Develop quality specific data needs / solutions for Star Rating performance management and insights development. Partner with enterprise data and analytics team to enhance tools and capabilities to drive efficiencies and flexibility for client specific needs. Represent Prime Quality Programs in RFP responses, at industry conferences, and at current and prospective client / finalist meetings.
• Other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in business, health services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required

• 10 years of work experience in Medicare Star Rating quality programs, analytics, audit, compliance, operational compliance, or related field
• 7 years of leadership/people management experience
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Strategic planning and execution
• Excellent written and verbal communication skills with the demonstrated ability of presenting program and project updates to senior executives
• Strong organizational, analytical, interpretative, and time management skills
• Strong interpersonal skills including team leadership and collaboration
• Understanding of CMS Star Rating regulatory requirements / technical specifications
• Strong commitment and proven track record of continuous quality improvement
• Demonstrated ability to identify and develop quality programs and process improvements

Preferred Qualifications

• Experience working with cross-functional partners both internally and externally
• Experience with analytical tools such as Excel, Access data bases, SaaS
• Strong client consulting presence: ability to distill complex material into easy to understand presentations, effectively respond to questions and engage a variety of audiences
• Ability to communicate effectively with senior leaders across the organization

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $143,000.00 - $243,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.