Pharmacy Business Analyst

Key Responsibilities

• Analyze pharmacy utilization patterns, claims data, and cost trends to identify opportunities for cost savings and improved patient outcomes.
• Develop and maintain reporting tools, dashboards, and performance metrics to track key pharmacy business indicators.
• Assist in the evaluation and optimization of the drug formulary to ensure cost-effective medication options are available to members.
• Monitor drug utilization and perform therapeutic class reviews to support formulary decision-making.
• Ensure adherence to CMS regulations and guidelines related to pharmacy benefits within the Medicare Advantage plan.
• Collaborate with compliance teams to conduct audits and prepare necessary documentation for regulatory reviews.
• Identify and analyze high-cost medications and utilization trends to develop strategies for managing pharmacy spend.
• Support the negotiation and management of pharmacy network contracts with providers and pharmacy benefit managers (PBMs).
• Work closely with clinical teams, marketing, and member services to ensure cohesive communication of pharmacy benefits to members and providers.
• Facilitate meetings with stakeholders to present findings, recommendations, and strategic initiatives.
• Lead and support pharmacy-related projects aimed at enhancing operational efficiency and improving member health outcomes.
• Track project progress, milestones, and outcomes, reporting on successes and areas for improvement.

Qualifications

• Education: Bachelor’s degree in Pharmacy, Health Administration, Business Administration, or a related field. A PharmD is preferred.
• Experience: Minimum of 3 years of experience in pharmacy benefits management, healthcare analytics, or a related field. Experience working with Medicare Advantage plans is highly desirable.
• Skills: Strong analytical skills with proficiency in data analysis tools (e.g., Excel, SQL, or business intelligence software). Knowledge of pharmacy benefit structures, formulary management, and Medicare regulations. Excellent communication and interpersonal skills, with the ability to collaborate across departments. Detail-oriented with strong organizational and project management abilities.
• Preferred Qualifications: Certification in pharmacy benefits management or healthcare analytics (e.g., CPBM, CPHQ) is a plus. Familiarity with pharmacy management systems and electronic health records (EHRs).