[Hiring] Director of Managed Care Pharmacy Analytics @SmartLight Analytics

Role Description

The Director of Managed Care Pharmacy Analytics leads two core components of our pharmacy product:

• Acts as the pharmacist voice on client calls, discussing payment integrity findings and creating analytics narratives.
• Serves as the clinical subject-matter expert on model development, ensuring payment integrity models are clinically and operationally sound.
• Brings command of PBM operations and analytics to drive realistic, actionable recommendations.
• Partners closely with the data science team and communicates findings independently with clients and PBMs.
• Collaborates with cross-functional teams to develop and implement pharmacy strategies.

Qualifications

• Education: PharmD, with a Managed Care Residency preferred; Training in analytic methods and/or pharmacy data analysis recommended.
• Experience:
  • Minimum 6–8 years in pharmacy benefit management with client-facing or PBM-facing experience.
  • Minimum 3 years analyzing pharmacy claims data, especially payment integrity issues.
  • Understanding of PBM operations, claims adjudication, and pricing/rebate terms.
  • Ability to interpret PBM contract terms and connect them to clinical and financial impact.
  • Comfortable partnering with an analytics team and discussing findings independently.
• Skills:
  • Strong executive presence; able to represent SmartLight independently.
  • Advanced knowledge of pharmacy benefits, PBM contracting, and operations.
  • Comfortable engaging with data science teams on model logic and validation.
  • Excellent communication skills for technical and non-technical audiences.
  • Strong collaboration and partnership skills across teams.
• Key Competencies:
  • Strong analytical and clinical judgment to identify patterns and trends.
  • Ability to drive change and influence PBM discussions based on data.
  • High attention to detail and commitment to quality and compliance.
  • Proactive, solution-oriented approach to client and PBM challenges.

Requirements

• Serve as the primary pharmacy/clinical subject-matter expert on client calls.
• Bring working knowledge of PBM operations, claims adjudication, and pricing/rebate terms.
• Act as the clinical lead for PBM RFP evaluations.
• Partner with the data science team to validate clinical logic behind pharmacy models.
• Ensure analytic capabilities make clinical and operational sense.
• Integrate payment integrity findings into broader PBM strategy.
• Stay current on healthcare regulations and pharmacy industry standards.
• Ensure alignment with government regulations and payer contract requirements.

Benefits

• Competitive salary and performance-based bonuses.
• Comprehensive health benefits package.
• Opportunities for professional development and training.
• Flexible work environment.

Company Description

SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce the wasteful spend in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.