[Hiring] Managed Care Pharmacy Analytics @SmartLight Analytics

Role Description

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

• Serves as the pharmacist voice on client calls, discussing payment integrity findings, creating and telling the story with analytics, and potentially acting as the clinical lead representing clients through PBM RFPs.
• Acts as the clinical subject-matter expert on model development, ensuring payment integrity models make clinical and operational sense.
• Brings command of PBM operations and analytics to drive realistic, actionable recommendations.
• Partners closely with the data science team and speaks to findings independently with clients and PBMs.
• Collaborates with cross-functional teams, including product, account management, legal advisors, operations, and technology, 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 of experience in pharmacy benefit management, with meaningful client-facing or PBM-facing experience.
  • Minimum of 3 years’ experience in analyzing pharmacy claims data, especially payment integrity issues.
  • Demonstrated understanding of how PBM operations work in practice, e.g., how claims adjudicate, how pricing/rebate terms are administered, and where contract terms and real-world operations diverge.
  • Demonstrated ability to interpret PBM contract terms (pricing guarantees, rebate arrangements, definitions) and connect them to clinical and financial impact.
  • Comfortable partnering closely with an analytics team and speaking independently to their findings.
• Skills:
  • Strong executive presence; able to represent SmartLight independently in front of clients and PBMs.
  • Advanced knowledge of pharmacy benefits, PBM contracting and operations, claims adjudication, and formulary/utilization management.
  • Comfortable engaging with data science teams on model logic, clinical assumptions, and validation.
  • Excellent communication skills, translating complex clinical and contractual findings for technical and non-technical audiences alike.
  • Strong collaboration and partnership skills, working effectively across teams without direct authority.
• Key Competencies:
  • Strong analytical and clinical judgment, with the ability to identify patterns, trends, and risk in pharmacy contract, claims, and operational data.
  • Ability to drive change and influence PBM discussions and outcomes based on data and clinical insight.
  • High attention to detail and commitment to quality and compliance.
  • A proactive, solution-oriented approach to client and PBM challenges.

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.