Director of Managed Care Pharmacy Analytics

🔥 2 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

💊 Pharmacist

👻 Ghost score 10%

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SmartLight Analytics

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2016

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

SmartLight Analytics is a healthcare analytics company that provides independent and ongoing monitoring of employee healthcare claims data. They focus on identifying and eliminating wasteful spending within health plans, ultimately lowering healthcare costs for self-funded employers without requiring changes in employee behavior. With a team of experts in data analysis, healthcare, and fraud investigation, SmartLight Analytics aims to improve healthcare benefits and promote high-value care for its clients while ensuring compliance with healthcare regulations.

📋 Description

• Lead pharmacy subject-matter expertise on client calls • Discuss payment integrity findings and translate analytics into actionable client narratives • Provide guidance on PBM operations, claims adjudication, pricing, and rebate terms • Potentially act as clinical lead for PBM RFP evaluations • Partner with data science teams on pharmacy model and AI/algorithm development • Validate formulary, utilization management, drug classification, specialty/LDD, trend, and anomaly-detection logic • Ensure analytic capabilities are clinically and operationally sound • Integrate payment integrity findings into broader PBM strategy and client narratives • Contribute to pharmacy offering strategy and payment integrity initiatives • Collaborate with product, account management, legal, operations, data science, and technology teams • Monitor healthcare regulations, pharmacy standards, and payer requirements • Ensure strategies align with CMS, CAA, government regulations, and payer contracts

🎯 Requirements

• PharmD required • Managed Care Residency preferred • Training in analytic methods and/or pharmacy data analysis recommended • Minimum 6–8 years of experience in pharmacy benefit management, with meaningful client-facing or PBM-facing experience • Minimum 3 years’ experience analyzing pharmacy claims data, especially payment integrity issues • Demonstrated understanding of PBM operations, including claims adjudication and pricing/rebate administration • Ability to interpret PBM contract terms and connect them to clinical and financial impact • Ability to partner with analytics teams and independently communicate findings • Advanced knowledge of pharmacy benefits, PBM contracting and operations, claims adjudication, and formulary/utilization management • Ability to engage with data science teams on model logic, clinical assumptions, and validation • Excellent communication skills for technical and non-technical audiences • Strong collaboration and partnership skills • Strong analytical and clinical judgment • High attention to detail and commitment to quality and compliance

🏖️ Benefits

• Full-time employment • Remote work arrangement

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