VP, Clinical Effectiveness and STARS Quality

AnewHealth 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 t