UNITE HERE HEALTH · 3 months ago
Manager of PBM Pharmacy Analytics
Oak Brook, IL
Full-time
Onsite
Senior Level
$125K/yr - $156K/yr
7+ years expUNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. The Manager of PBM Pharmacy Analytics leads the analysis and interpretation of pharmacy benefit management data to support clinical, operational, and financial initiatives, overseeing data governance and ensuring data quality.
ConsultingHealth CareHospitalNon Profit
Responsibilities
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
Qualification
Required
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
Benefits
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
Employee Assistance Program (EAP)
Company
UNITE HERE HEALTH
Unite Here Health is a non-profit organization that provides health benefits and healthcare services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Angela Riley, MD
CEO Hospitality Rx
Matthew Walker
CEO
Company data provided by crunchbase