United States onlyAnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.
Job Details
The VP, Clinical Effectiveness and Stars Quality is a senior healthcare leader responsible for advancing clinical effectiveness and Stars quality and safety program innovation for ExactCare Pharmacy. This role drives strategies to ensure excellence in value proposition performance for PBM and Health Plan clients of ExactCare Pharmacy as we strive to be the best pharmacy in the marketplace to support adherence and overall Stars performance.
Serving as a champion for clinical best practices, the Vice President establishes and oversees systems that promote measurable outcomes, continuous improvement, and payer satisfaction. This leader partners cross-functionally to enhance efficiency, support growth, and align all programs with the organization’s strategic payer goals. This role will support the development and management of strategic clinical and quality partnerships with health plans, PBMs, and other key external stakeholders to drive demand for our AnewHealth pharmacy services.
This role will also support network pharmacy contracting negotiations by providing strategic guidance on quality and Stars market trends, policy changes; and drive ExactCare Pharmacy clinical effectiveness and Stars experience performance to support reimbursement strategies. The VP will collaborate closely with internal teams to align business goals, operational goals, and growth initiatives. This role requires intense cross-functional collaboration and leadership of industry, products, and people.
Responsibilities
Drives operational strategies to enhance clinical effectiveness and Stars performance to increase pay for performance revenue for ExactCare Pharmacy
Drives Stars revenue for payers and associated value for ExactCare Pharmacy
Collaborates to establish and manage payer performance expectations including Stars, outcomes, and value-based programs (e.g., quality bonus programs)
Supports network pharmacy contract negotiations with subject matter clinical effectiveness and quality expertise and demonstrated ExactCare Pharmacy performance
Develop and lead clinical effectiveness and Stars quality improvement strategy to support payer value proposition for ExactCare Pharmacy
Serves as expert in understanding Medicare and CMS quality drivers for payer revenue
Design clinical programs aimed at optimizing quality performance and evidence-based care
Provide leadership and direction on clinical effectiveness and quality strategy
Identify, prioritize, and execute on quality initiatives
Interpret quality performance, identify trend, and design improvement strategies
Monitor marketplace trends, literature, professional organizations, and regulatory bodies for new or revised best practices and standards related to clinical effectiveness and pharmacy patient care
Interpret clinical effectiveness and Stars performance metrics, help identify trend, and design improvement strategies
Continually improve and support implementation of clinical effectiveness, quality, and patient safety measurement strategy
Support and facilitate implementation of innovation and systems that improve clinical effectiveness, and Stars experience to drive overall improved pharmacy quality and payer value proposition
Support relationship managers with value proposition to solve patient experience barriers with health plans and PBMs including co-pay differential and medication synchronization fulfillment timing and overrides
Build relationships and advocacy with key external clinical partners within Health Plans and PBMs to stimulate, surface, and shape demand for ExactCare Pharmacy services
Support new opportunities for value creation
Ensure strong clinical effectiveness and quality service levels are achieved to support relationship managers with strong value messages during payer meetings and QBRs.
Stay on top of clinical, quality and Medicare trends and information with health plans and PBMs that can impact the business, keeping leadership and key stakeholders informed of changes (e.g., policy, reimbursements)
The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned to be similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.
Qualifications
These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required: Doctor of Pharmacy Degree; Health Plan/PBM Medicare Quality performance experience.
Preferred: Advanced degree in Business/Business Administration, Healthcare, or related field.
Required: 10+ years of progressive experience in client relationship management or supporting client relationship owners with clinical program subject matter expertise to drive value from strategic partnerships.
Strongly Preferred: Strong understanding/experience in healthcare, particularly with Medicare quality / safety performance with health plans and PBMs.
Skills & Abilities
Required: Proven ability to build and/or support effective partnerships to drive increased value and expanded business opportunities.
Required: Adept at creating productive, long-term customer relationships.
Required: Excellent written and verbal communication skills, and professionalism when working with account stakeholders
Required: Can model positive energy and handle stress in the face of challenges, deadlines, and financial pressures in a fast-paced, dynamic environment
Required: Ability to successfully perform with key decision makers at the Executive/C-Suite level of mid-size and large companies.
Required: Experience conducting presentations to groups
Required: Detail oriented and able to prioritize workload
Required: Strong computer skills including using Word processors, spreadsheets, and database software
Preferred: Ability to manage multiple priorities and work independently
Preferred: Demonstrated leadership skills
Physical & Mental Demands
This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within assigned territory. May be necessary to work extended hours as needed.
Schedule
This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. This may be considered a hybrid position based on manager discretion.
Travel
Travel will be required for special department events, trade shows, conferences, and other client engagements.
AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.
AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.
