Medical Informatics Analyst, Consultant - Pharmacy Strategy and Operations

About the role

The Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations at Blue Shield of California (BSC).

Responsibilities

• Conduct independent analysis of high complexity under minimal supervision and guidance
• Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
• Produce analysis of high complexity under the guidance and direction of Medical Informatics Analyst Principal, supervisor or manager
• Create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team
• Support Clinical Pharmacy Program Analytics & Reporting, including adherence and other reporting to support HEDIS and Medicare Stars initiatives
• Support Pharmacy Medicare and Medi-Cal Analytics and Reporting
• Support Pharmacy Operational analyses and reporting, as needed
• Support Pharmacy Cost of Health Care analyses and reporting, as needed
• Support Operation Analytics, including member mailings, Prior Authorization, Benefits & Claims
• Support Pharmacy Infomart implementation and Netezza Sandbox retirement
• Drive team strategy around self-service reporting tools (e.g., Tableau, SAS Viya, etc.)
• Track cost and utilization of specialty drugs on Rx and Medical benefit for LOB and Employer Group reporting
• Support monitoring of Financial Contract Performance with Stellarus teams (e.g., Service Provider Network Performance, Evio)
• Lead evaluation of COHC savings for pharmacy initiatives
• Provide pharmacy utilization and cost reports to evaluate trend drivers
• Track cost and utilization of specialty drugs on Pharmacy and Medical benefit for Line of Business and Employer Group reporting
• Support Clinical Pharmacy Program Analytics, as needed

Qualifications

• Requires a college degree or equivalent experience
• Requires 7 years of prior relevant experience, and 5 years of experience as a Health Data Analyst, Medical Economist, or in a related role within a healthcare setting
• Additionally, 5 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims data sets is required
• Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred
• Data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS Viya, Snowflake SQL, Tableau)
• Ability to leverage business and data knowledge to interpret health plan benefit utilization
• Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds