Senior Healthcare Informatics Analyst - Pharmacy Analytics

Role Description

The Senior Healthcare Informatics Analyst position is pharmacy-centric and requires experience with Databricks, SQL, and SAS. Pharmacy Analytics independently provides advanced analytics to support understanding and improvement of pharmacy benefit utilization, cost, quality, and clinical outcomes. This role develops analytic attributes related to:

• Pharmacy utilization management
• Drug cost optimization
• Formulary performance
• Medication adherence
• Provider/member pharmacy engagement

In collaboration with Pharmacy, Clinical, Actuarial, Finance, and IT partners, this position leads complex problem solving, solution development, and data-driven strategic decision making. Accountable for compliance with all applicable laws and regulations associated with pharmacy data and analytics responsibilities.

The analyst supports enterprise initiatives across Pharmacy Operations, Medical Management, Actuarial, and Clinical teams, serving as a subject matter expert in pharmacy analytics and translating complex business questions into actionable insights.

Qualifications

• Bachelor's degree in Healthcare Administration, Pharmacy, Public Health, Statistics, Economics, Analytics, Computer Science, or a related field required.
• Master's degree in a related field preferred.
• Four years of related experience may substitute for a Bachelor's degree.
• Four (4) years of healthcare analytics experience, with pharmacy or PBM analytics experience strongly preferred.
• Experience analyzing pharmacy claims, formulary performance, drug mix, utilization trends, rebates, and adherence metrics (PDC/MPR).
• A Master's degree may substitute for two years of required experience; a Doctorate may substitute for an additional two years.
• Strong critical thinking, analytical, and problem-solving skills.
• Experience building predictive and explanatory models related to pharmacy utilization, cost, and outcomes.
• Knowledge of pharmacy outcomes research, utilization management, and drug trend analysis preferred.
• Advanced knowledge of SAS (including Enterprise Miner) preferred.
• Strong working knowledge of the U.S. healthcare system in a payer setting, with specific understanding of pharmacy benefits and PBM operations.

Requirements

• Proficiency with Databricks, SQL, SAS, Python, R, Tableau, and other analytics and visualization tools.
• Knowledge of pharmacy pricing and payment methodologies (AWP, WAC, MAC, rebates, trend drivers).
• Understanding of population health and pharmacy-driven interventions.
• Familiarity with risk adjustment concepts and pharmacy's role in total cost of care.
• Knowledge of clinical groupers and classification systems including GPI, NDC, therapeutic class, DRG, HCC, and related models.
• Understanding of pharmacy-related quality metrics including HEDIS medication measures and STAR Ratings.
• Knowledge of commercial and Medicare Advantage pharmacy optimization.
• Excellent verbal and written communication skills.
• Ability to translate complex pharmacy analytics into clear insights for executive, clinical, and technical audiences.

Accountabilities and Essential Functions

• Lead the selection and application of pharmacy-focused analytic, evaluation, and business intelligence methodologies to support business decisions and strategic planning.
• Leverage pharmacy claims data, PBM feeds, enterprise data sources, and external datasets to deliver actionable insights.
• Independently partner with business teams to define pharmacy analytics needs and develop predictive models, dashboards, utilization analyses, and performance metrics.
• Serve as a pharmacy analytics advisor on enterprise and cross-functional initiatives.
• Translate pharmacy business rules and policies into analytical models and reporting solutions while acting as a liaison between Pharmacy, Analytics, IT, and Enterprise Information Management teams.
• Perform peer data quality reviews to ensure accuracy, completeness, and consistency of pharmacy analytics output.
• Conduct advanced descriptive and statistical analyses related to drug utilization, adherence, cost drivers, and clinical outcomes.

Additional Information

• Performs other job-related duties as assigned within the scope of responsibility.
• Work is performed in a standard office environment.
• Position is primarily sedentary.
• Ability to analyze, interpret, document, and communicate complex data is required.