Manager of PBM Pharmacy Analytics

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

We are looking for a candidate who has worked directly for a PBM (pharmacy benefit management) organization and who has a strong understanding of PBM pharmacy claims data and healthcare analytics.

The Manager of PBM Pharmacy Analytics leads the analysis and interpretation of pharmacy benefit management data to support clinical, operational, and financial initiatives.  This important work enables data-driven decision-making and strategic planning across the PBM. This role oversees pharmacy data governance, ensures data quality and integrity, and supports the development and delivery of reporting and analytics solutions.

 ESSENTIAL JOB FUNCTIONS AND DUTIES 

• Gather and compile pharmacy data from various sources (claims, prescriptions, networks) and analyze it to identify trends, patterns, and anomalies
• Develop, build, and maintain reports, dashboards, and visualizations to track key performance indicators (KPIs) for leadership and management
• Perform cost-benefit analysis and cost-effectiveness studies for various medications and treatment options, assessing the impact of benefit design changes
• Assist with input of formulary and drug management requirements to data warehouse, oversight of formulary and drug management tables
• Ensure that pharmacy benefit programs comply with relevant healthcare regulations and assist with compliance reporting and audits
• Provide data-driven recommendations for optimizing pharmacy benefit programs, including formulary management, prior authorization criteria, and cost-saving strategies
• Partner with cross-functional teams to interpret data findings and implement recommended changes
• Ensure the accuracy, integrity, and completeness of PBM data by implementing and monitoring data validation processes
• Conduct ad-hoc data analysis and support special projects as needed to address evolving business needs
• Communicate findings of data investigations and manage expectations for internal and external stakeholders
• Maintains a thorough understanding of the data warehouse process, PBM contract requirements, reconciliations, vendor agreements, reporting applications and reporting requirements
• Helps execute strategic vision for data warehouse enhancements/improvements to serve Analytics departmental needs
• Reviews and corresponds to vendor requests and inquiries for data transfer activities
• Maintains a high level of professionalism and sense of urgency to ensure PBM expectations are consistently met
• Reviews and completes financial sections of RFP/RFIs, market checks, and contract renewals and forecasts accurate cost assumptions into pricing offers
• Exemplifies the Fund's values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement

ESSENTIAL QUALIFICATIONS 

• 4 years of experience working at a PBM
• 7~10 years or more years’ experience in data analytics, with a specific focus on PBM pharmacy data and the ability to format reports and explain results
• Bachelor's degree in a quantitative field such as Data Science, Statistics, or Health Policy
• Strong understanding of PBM operations, including benefit plan design, formulary management, claims adjudication, and eligibility processing
• Experience working with data warehouses, large datasets, and structured/unstructured data sources
• Strong understanding of PBM pharmacy claims data and healthcare analytics
• Working knowledge of industry coding (revenue codes, International Classification of Diseases (ICD) 9 or 10’s, Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) codes, Medispan, etc.)
• Working knowledge of Formulary and Drug management concepts (Tiers, Prior Authorization, Quantity Limits, Step Therapy, etc.)
• Organizational and time management skills to prioritize workload and meet deadlines required
• Must be results oriented with the ability to change priorities as needed, and an ability to manage complex projects
• Excellent verbal and written communication, client-facing, and organizational skills
• Familiarity with claims processing systems (e.g., RxCLAIM) and Medispan or First Databank)
• Proficiency with project management tools (e.g., MS Project, Jira, Smartsheet) and Microsoft Office Suite
• Advanced skills in data visualization tools like Tableau, Power BI, or Looker
• Advanced proficiency in writing complex and optimized SQL queries is essential
• A strong understanding of the complexities of the pharmacy benefits industry, including data structures, common analytics, and healthcare regulations

Salary range for this position: Salary $124,900 to $156,200. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday thru Friday, 7.5 hours per day (37.5 hours per week) as a remote employee (central time zone preferred).

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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