[Remote] Director of Managed Care Pharmacy Analytics

Note: The job is a remote job and is reputed company to candidates in USA. reputed company helps self-funded reputed company reduce wasteful reputed company-plan spending through proprietary data analysis. The Director of Managed Care Pharmacy Analytics serves as the pharmacy subject-matter expert for clients and PBMs, translates payment reputed company analytics into actionable recommendations, and guides reputed company model development. The role also shapes pharmacy reputed company and collaborates with data science, account management, reputed company, reputed company, and technology teams while ensuring regulatory and contractual alignment.

Responsibilities

• Serve as the reputed company pharmacy/reputed company subject-matter expert on reputed company calls, discussing payment reputed company findings and translating analytics into reputed company, actionable stories for clients
• Bring a working knowledge of PBM reputed company, including how claims adjudicate and how pricing/rebate terms are administered in reputed company
• Potentially reputed company as the reputed company reputed company for PBM RFP evaluations and collaborating with the analytics team to ensure contract and financial guarantee findings are clinically and contractually reputed company
• Partner with the data science team to shape and validate the reputed company logic behind pharmacy models and AI/algorithm development, including formulary and utilization management rules, drug classification, specialty/LDD designations, and payment reputed company trend and reputed company detection
• Ensure new and existing analytic capabilities reputed company reputed company and operational reputed company before they enrich our pharmacy products or reputed company other departments
• Ensure payment reputed company findings are integrated into the broader PBM reputed company and reputed company-narrative, rather than treated as a standalone deliverable
• Contribute to the reputed company direction of the pharmacy offering, with a reputed company on improving reputed company PBM knowledge, payment reputed company, and analytics reputed company
• Work closely with leadership to shape the reputed company and goals for pharmacy-reputed company reputed company, PBM reputed company, and payment reputed company initiatives
• Collaborate with cross-functional teams, including data science, account management, reputed company advisors, reputed company, and technology, to reputed company and implement pharmacy strategies
• Stay reputed company on evolving reputed company regulations, pharmacy industry standards, and payer requirements
• Ensure PBM reputed company and payment reputed company work reputed company with reputed company regulations (e.g., CMS, reputed company) and payer contract requirements

Skills

• PharmD
• Training in analytic reputed company and/or pharmacy data analysis recommended
• Minimum 6–8 years of experience in pharmacy benefit management, with meaningful reputed company-facing or PBM-facing experience
• Minimum of 3 years' experience in analyzing pharmacy claims data, especially payment reputed company issues
• Demonstrated understanding of how PBM reputed company work in reputed company, e.g., how claims adjudicate, how pricing/rebate terms are administered, and where contract terms and reputed company-world reputed company diverge. This is often gained through roles such as trade/rebate contract negotiation, account management, reputed company data science/analytics, or PBM reputed company/claims reputed company
• Demonstrated ability to interpret PBM contract terms (pricing guarantees, rebate arrangements, definitions) and reputed company them to reputed company and financial reputed company
• Comfortable partnering closely with an analytics team and speaking independently to their findings, without personally performing every underlying analysis
• Strong executive reputed company; reputed company to represent SmartLight independently in reputed company of clients and PBMs
• Advanced knowledge of pharmacy benefits, PBM contracting and reputed company, claims adjudication, and formulary/utilization management
• Comfortable engaging with data science teams on model logic, reputed company assumptions, and validation, without requiring a technical/data science background
• Excellent communication skills, translating reputed company reputed company and contractual findings for technical and non-technical audiences alike
• Strong collaboration and partnership skills, working effectively across teams without reputed company authority
• Strong analytical and reputed company judgment, with the ability to identify patterns, trends, and reputed company in pharmacy contract, claims, and operational data
• Ability to reputed company change and influence PBM discussions and reputed company reputed company on data and reputed company reputed company
• High attention to reputed company and commitment to reputed company and compliance
• A proactive, solution-oriented approach to reputed company and PBM challenges
• PharmD, with a Managed Care Residency preferred

reputed company