[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 a clinical subject-matter expert on model development, ensuring payment integrity models are clinically and operationally sound.
• 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 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, pricing/rebate terms, and contract 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, claims adjudication, and formulary/utilization management.
  • Comfortable engaging with data science teams on model logic and clinical assumptions.
  • Excellent communication skills for translating complex findings for various audiences.
  • Strong collaboration and partnership skills across teams.
• Key Competencies:
  • Strong analytical and clinical judgment to identify patterns and risks in pharmacy data.
  • Ability to drive change and influence PBM discussions based on data and clinical insight.
  • 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 a working knowledge of PBM operations.
• Potentially act as the clinical lead for PBM RFP evaluations.
• Partner with the data science team to shape and validate clinical logic behind pharmacy models.
• Ensure analytic capabilities make clinical and operational sense.
• Integrate payment integrity findings into broader PBM strategy.
• Contribute to the strategic direction of the pharmacy offering.
• Stay current on evolving healthcare regulations and industry standards.
• Ensure alignment with government regulations and payer contract requirements.

Benefits

• Opportunity to make a meaningful impact on healthcare costs.
• Work with a team of industry insiders focused on reducing wasteful spending.
• Engage in proprietary data analysis to improve client outcomes.

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. SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plans through proprietary data analysis.