Lead Informaticist, Medicaid Pharmacy Forecasting

Become a part of our caring community The Lead Informaticist, Medicaid Pharmacy Forecasting owns the drug- and market-level utilization forecast for every Medicaid state Humana supports. This role is responsible for producing a forecast that is robust, defensible, and decision-ready—and for clearly explaining to executive stakeholders where variance is coming from when actuals diverge from expectations. This is a hands-on quantitative role with significant cross-functional visibility. The Lead Informaticist personally designs the forecasting methodology, builds and maintains the models, accounts for the operational realities of Medicaid (state-by-state data differences, cohort dynamics, new-state launches, benefit and formulary changes, regulatory shifts), and translates results into executive-ready narratives that leaders use to plan, intervene, and communicate with internal and state partners. The role operates in a Databricks environment and is expected to leverage AI agents and modern coding tools to accelerate model iteration, scenario analysis, and explanatory analytics. Use your skills to make an impact Key Responsibilities 1) Own Medicaid Drug- and Market-Level Forecasting End-to-End Design, build, and maintain forecasts for drug-level utilization (script counts, days supply, cost, mix) and market-level utilization for each Medicaid state Humana supports. Produce forecasts at the cadence required by the business (e.g., monthly refresh, ad-hoc scenarios, launch projections, annual planning). Maintain a forecasting framework that is transparent, reproducible, and version-controlled—so results are traceable and defensible to executive and partner audiences. 2) Account for the Realities of Medicaid Explicitly handle state-by-state differences in: Data availability, completeness, and lag Member cohort composition, eligibility patterns, churn, and risk mix Benefit design, formulary, PDL, and prior authorization policies Provider, pharmacy network, and dispensing patterns Regulatory and reimbursement environment (FFS vs. MCO, carve-in/carve-out, supplemental rebate dynamics) Build forecasting approaches that accommodate new-state launches—including ramp curves, cold-start handling, lookalike methods, and Bayesian shrinkage or hierarchical approaches when state-specific history is thin or absent. Account for drug-specific dynamics: new launches, LOEs/generic entrants, biosimilar uptake, indication expansions, GLP-1 and other category-level disruptions, and seasonality. 3) Build Methodologically Sound, Robust Forecasts Select and apply the right method for the problem—e.g., classical time series (ARIMA, ETS, state-space), hierarchical and panel models, regression-based decomposition, machine learning (gradient boosting, regularized regression), Bayesian hierarchical models, and ensembles—with clear justification for the chosen approach. Quantify and communicate uncertainty (intervals, scenarios, sensitivity) rather than presenting point estimates alone. Stress-test forecasts against historical analogs, holdout periods, and reasonable counterfactuals; document assumptions explicitly. Establish and monitor forecast accuracy metrics (e.g., MAPE, WAPE, bias, calibration) at appropriate levels of granularity, and continuously improve methodology based on observed performance. 4) Variance Explanation & Executive Communication When actuals deviate from forecast, diagnose and clearly explain the drivers of variance to executive stakeholders—decomposing variance into intuitive components such as: Membership / cohort change Mix shift (drug, category, channel, state) Unit cost / rate change Utilization rate change Launches, LOEs, policy changes, and one-time events Build standing variance and attribution analytics so leaders see what changed, why it changed, and what it means every cycle—not just what the number is. Translate technical results into concise executive narratives that anticipate the questions VPs and SVPs will ask. 5) Partner with Stakeholders and Drive Decisions Partner with clinical strategy, pricing, network, finance, actuarial, Medicaid market leadership, and state-facing teams to ensure forecasts reflect the best available business intelligence and operational reality. Support new-state launch readiness by producing pre-launch forecasts, sensitivity ranges, and post-launch tracking against expectations. Translate forecast insights into clear options and recommended actions—e.g., where to intervene, where to escalate, where to adjust assumptions—so leaders can act, not just observe. 6) AI-Accelerated Forecasting & Tooling Leverage AI agents, copilots, and modern coding tools to accelerate model development, feature engineering, code review, scenario testing, and explanatory analytics. Operate hands-on in Databricks using Python, PySpark, and/or SQL, with reproducible pipelines and clear documentation. Establish good engineering hygiene for the forecasting codebase: parameterization, configuration, testing, and reusable components that support extensibility as new states, drugs, and scenarios are added. 7) Elevate the Practice Document methodology, assumptions, and known limitations clearly so the forecast is understandable and maintainable by others. Mentor more junior analysts on forecasting technique, variance decomposition, and executive communication. Stay current on changes in Medicaid policy, and pharmacy market dynamics, and translate developments into forecast improvements. Use your skills to make an impact Required Qualifications Bachelor's degree (or equivalent experience) in a quantitative discipline (Statistics, Economics, Data Science, Operations Research, Mathematics, Actuarial Science, Health Services Research, or related); advanced degree preferred. 5+ years of progressive quantitative analytics experience, with 3+ years specifically in forecasting (utilization, demand, financial, or comparable). Demonstrated experience producing drug-, product-, or market-level forecasts in a healthcare, pharmacy, payer, PBM, or comparable setting. Strong hands-on proficiency in Python, PySpark, and/or SQL, with the ability to build and maintain reproducible forecasting pipelines. Working knowledge of forecasting methods across classical time series, regression-based, and machine learning approaches; ability to choose and defend the right method for the problem. Demonstrated experience explaining forecast variance to non-technical executives in clear, decomposable terms. Comfort with leveraging AI agents and coding tools to accelerate analysis and iteration. Strong written and verbal communication skills, with a track record of translating quantitative work into executive-ready narratives. Preferred Qualifications Experience working in Databricks or comparable lakehouse environments. Direct experience with Medicaid pharmacy data and an understanding of state-by-state operational, regulatory, and data realities. Familiarity with handling cold-start / new-market launches (e.g., hierarchical models, lookalike approaches, Bayesian shrinkage). Experience with uncertainty quantification (prediction intervals, Bayesian methods, scenario modeling). Familiarity with pharmacy-specific dynamics: launches, LOEs, biosimilars, GLP-1 category disruption, formulary/PDL change impacts, and PA policy effects. Experience standing up standing variance/attribution analytics that explain "what changed and why" each cycle. Track record of partnering directly with finance, actuarial, clinical, and market leadership teams. Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $117,600 - $161,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-16-2026 About us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being. About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.