Medical Informatics Analyst, Consultant - Pharmacy Strategy and Operations

Your Role The Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations at Blue Shield of California (BSC). The Rx Analytics and Reporting team drives analytics strategy and performs clinical and business analyses to provide consultations and strategic program recommendations. The Medical Informatics Analyst, Consultant, Clinical Programs Analytics will report to the Manager, Medical Informatics. In this role you will support either Clinical Programs Analytics, Operational Analytics, or Cost of Health Care Analytics. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow -- personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Work Conduct independent analysis of high complexity under minimal supervision and guidance Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels Produce analysis of high complexity under the guidance and direction of Medical Informatics Analyst Principal, supervisor or manager Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conduct formal training sessions for lower-level analysts and analysts in other Departments Support Clinical Pharmacy Program Analytics & Reporting, including adherence and other reporting to support HEDIS and Medicare Stars initiatives Lead Accountable Care Organization and Provider Pharmacy Analytics & Reporting Support Pharmacy Medicare and Medi-Cal Analytics and Reporting Support Pharmacy Operational analyses and reporting, as needed Support Pharmacy Cost of Health Care analyses and reporting, as needed Support Operation Analytics, including member mailings, Prior Authorization, Benefits & Claims Support Pharmacy Infomart implementation and Netezza Sandbox retirement Drive team strategy around self-service reporting tools (e.g., Tableau, SAS Viya, etc.) Track cost and utilization of specialty drugs on Rx and Medical benefit for LOB and Employer Group reporting Support monitoring of Financial Contract Performance with Stellarus teams (e.g., Service Provider Network Performance, Evio) Lead evaluation of COHC savings for pharmacy initiatives Provide pharmacy utilization and cost reports to evaluate trend drivers Track cost and utilization of specialty drugs on Pharmacy and Medical benefit for Line of Business and Employer Group reporting Support Clinical Pharmacy Program Analytics, as needed Your Knowledge and Experience Requires a college degree or equivalent experience Requires 7 years of prior relevant experience, and 5 years of experience as a Health Data Analyst, Medical Economist, or in a related role within a healthcare setting. Additionally, 5 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims data sets is required Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred Data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS Viya, Snowflake SQL, Tableau) Ability to leverage business and data knowledge to interpret health plan benefit utilization Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds Hybrid Work Model This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need. About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Together, these organizations are referred to as the Ascendiun Family of Companies. Our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. Equal Employment Opportunity All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. #J-18808-Ljbffr Blue Shield of California