Director, Network Informatics & Analytics

About the role

The Director, Network Informatics & Analytics is a strategic leadership role responsible for the data, informatics, analytics, and quality governance that support pharmacy network contracting across Chain, Specialty, and Independent/Affiliated networks.

Responsibilities

• Data Governance & Informatics Leadership
• Own and evolve the informatics framework supporting pharmacy network contracting, including contract attributes, reimbursement methodologies, network hierarchies, and provider identifiers
• Establish and maintain data standards, definitions, and governance controls to ensure data consistency, usability, and integrity across systems and reporting environments
• Serve as the centralized authority for network and contract data quality, enabling reliable and scalable analytics
• Advanced Analytics & Network Modeling
• Design and develop network models to evaluate reimbursement structures, pricing strategies, and financial impact across pharmacy segments
• Build analytical frameworks to assess provider cost, performance, and value (e.g., scorecards, cost-of-care, network efficiency)
• Identify optimization opportunities through scenario modeling, trend analysis, and performance insights
• Partner with Finance, Actuarial, and Strategy teams to support forecasting, pricing decisions, and client-facing analytics
• Reporting & Insights
• Lead development and maintenance of standardized reporting and dashboards for network performance, reimbursement trends, and contract alignment
• Deliver actionable insights through routine and ad hoc analyses, including trend identification, outlier detection, and emerging risk monitoring
• Establish KPI frameworks to measure network effectiveness, cost efficiency, and overall performance across pharmacy segments
• Quality Oversight & Analytical Validation
• Establish and oversee analytical quality control frameworks to assess alignment between contract intent and observed claims and network performance outcomes
• Develop monitoring approaches that surface discrepancies, emerging risks, or unintended financial impacts
• Perform root cause analysis and partner with cross-functional teams to inform resolution strategies (without direct ownership of execution)
• Implementation Insights & Post-Implementation Visibility
• Provide analytical insight into the performance of new network builds, contract changes, and reimbursement updates through evaluation of claims outcomes and network performance
• Partner with Network Contracting and Provider Services Operations to support visibility into implementation outcomes and emerging trends
• Develop analytics and reporting that assess whether network design intent is reflected in observed performance
• Surface risks, anomalies, or unintended financial impacts resulting from network or contract changes
• Cross-Functional Partnership
• Serve as a key analytics and informatics partner to Network Contracting leadership across all pharmacy segments
• Collaborate with Analytics, Finance, IT, Compliance, Legal, and Operations to ensure data transparency, alignment, and visibility into key issues
• Support enterprise initiatives including new client implementations, regulatory changes, and network expansion strategies

Qualifications

• Bachelor’s degree in Business, Finance, Analytics, Information Systems, Healthcare Administration, or related field, or equivalent work experience, required.
• 7+ years of progressive experience in PBM, healthcare analytics, PBM network operations (not IT networks), pharmacy informatics or equivalent experience required.
• 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required.
• Demonstrated experience with claims data, network configuration, reimbursement models, and complex data environments required.
• Proven ability to lead analytics, reporting, or informatics functions in a regulated healthcare setting required.
• Experience supporting contracting, pricing, or network management functions strongly preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.