Director of Managed Care Pharmacy Analytics

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Description

The Director of Managed Care Pharmacy Analytics leads two core components of our pharmacy product. First, in an externally facing, subject-matter-expert capacity, this role serves as the pharmacist voice on client calls, discussing payment integrity findings, creating and telling the story with analytics, and potentially acting as the clinical lead representing clients through PBM RFPs. Second, the this role acts as the clinical subject-matter expert on model development, ensuring payment integrity models make clinical and operational sense. Across both, this role brings enough command of PBM operations and analytics to drive realistic, actionable recommendations, partners closely with the data science team, and speaks to findings independently with clients and PBMs. This Position also collaborates with cross-functional teams, including product, account management, legal advisors, operations, and technology, to develop and implement pharmacy strategies. Key Responsibilities Client PBM Guidance: Serve as the primary pharmacy/clinical subject-matter expert on client calls, discussing payment integrity findings and translating analytics into clear, actionable stories for clients. Bring a working knowledge of PBM operations, including how claims adjudicate and how pricing/rebate terms are administered in practice. Potentially act as the clinical lead for PBM RFP evaluations and collaborating with the analytics team to ensure contract and financial guarantee findings are clinical

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