Business Architect Consultant - Part D Stars Strategy

Responsibilities

• Part D Stars Strategy & Execution
• Lead the execution of the Medicare Part D Stars strategy in alignment with organizational goals and CMS technical specifications.
• Own performance management for Part D Stars measures, including adherence, medication safety, MTM, pharmacy quality measures, and leading indicators/KPIs.
• Translate annual CMS updates into operational plans and performance targets.
• Support multi‑year improvement planning and monitor progress against Stars goals.
• Analytics, Reporting & Forecasting
• Direct development and maintenance of Stars performance dashboards and reporting for leadership and operational teams.
• Partner with Stars and analytics teams to develop forecasting models, cut point scenarios, and risk assessments.
• Monitor measure trends and identify emerging risks or improvement opportunities.
• Cross‑Functional Collaboration
• Collaborate with pharmacy operations, PBM partners, clinical programs, Stars and Product teams, and vendors to implement Stars improvement initiatives.
• Partner with compliance and regulatory teams to support audit readiness and CMS inquiries.
• Serve as a trusted advisor to leaders by clearly communicating performance insights and recommended actions.
• What You Bring
• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.
• Bonus Points (preferred qualifications)
• Bachelor's degree required; Master's degree in Public Health, Pharmacy, Analytics, Business, or a related field preferred.
• PharmD, MPH, MS in Analytics, or similar advanced degree.
• 5-8 years of experience in Medicare Part D Stars, pharmacy quality, PBM operations, or health plan analytics.
• Strong working knowledge of Medicare Part D Stars measures, methodology, and CMS technical specifications.
• Experience with MTM programs, adherence interventions, or pharmacy operations.
• Familiarity with CMS systems and regulatory submissions (e.g., HPMS).
• Experience using tools such as Power BI or Tableau.
• Demonstrated success managing complex, cross‑functional initiatives.
• Strong analytical and problem‑solving skills with experience interpreting performance data and forecasts.
• Effective written and verbal communication skills, including experience presenting to senior leaders.
• What You'll Get
• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Learn more
• Where You'll Work
• Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused.
• In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter.
• Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.
• Salary Range
• At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including

Benefits

Additional Information

Job Description We're seeking a Business Architect Consultant to join our Government Pharmacy Programs Department! The Business Architect Consultant (BAC), Part D Stars Strategy is accountable for driving the day to day strategy, execution, and performance management of Medicare Part D Star Ratings. This role serves as the operational and analytical lead for Part D Stars, translating CMS requirements and performance insights into actionable improvement initiatives that support the organization's goal of achieving and sustaining 4+ Star performance. The BAC partners closely with pharmacy operations, analytics, PBM partners, product, Stars and quality teams, and plays a critical role in enabling informed decision making through data, forecasting, and program oversight.

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