Director of Pharmacy Analytics

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

💊 Pharmacist

👻 Ghost score 13%

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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

• Serve as the primary pharmacy/clinical subject-matter expert on client calls • Discuss payment integrity findings and translate analytics into clear, actionable stories for clients • Bring working knowledge of PBM operations, including claims adjudication and pricing/rebate administration • Potentially act as clinical lead for PBM RFP evaluations • Collaborate with analytics teams to ensure contract and financial guarantee findings are clinically and contractually sound • Partner with data science teams to shape and validate clinical logic behind pharmacy models and AI/algorithm development • Validate formulary and utilization management rules, drug classification, specialty/LDD designations, and payment integrity trend and anomaly detection • Ensure analytic capabilities make clinical and operational sense before integration into pharmacy products or other departments • Integrate payment integrity findings into broader PBM strategy and client narratives • Contribute to the strategic direction of the pharmacy offering • Work with leadership to shape pharmacy strategy, PBM operations, and payment integrity initiatives • Collaborate with data science, account management, legal, operations, and technology teams to develop and implement pharmacy strategies • Stay current on healthcare regulations, pharmacy industry standards, and payer requirements • Ensure PBM strategy and payment integrity work align with CMS, CAA, government regulations, and payer contract requirements

🎯 Requirements

• PharmD • 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 of 3 years’ experience in analyzing pharmacy claims data, especially payment integrity issues • Demonstrated understanding of PBM operations, including claims adjudication, pricing/rebate terms, and divergence between contract terms and real-world operations • Demonstrated ability to interpret PBM contract terms and connect them to clinical and financial impact • Comfortable partnering with analytics teams and speaking independently to findings • Strong executive presence and ability to represent SmartLight independently in front of clients and PBMs • Advanced knowledge of pharmacy benefits, PBM contracting and operations, claims adjudication, and formulary/utilization management • Comfortable engaging with data science teams on model logic, clinical assumptions, and validation • Excellent communication skills for translating complex clinical and contractual findings to technical and non-technical audiences • Strong collaboration and partnership skills • Strong analytical and clinical judgment • Ability to identify patterns, trends, and risk in pharmacy contract, claims, and operational data • Ability to drive change and influence PBM discussions and outcomes based on data and clinical insight • High attention to detail and commitment to quality and compliance • Proactive, solution-oriented approach to client and PBM challenges