Sr. Pharmacy Data Analyst Manager at Unite Here Health

• Gather and compile pharmacy data from various sources (claims, prescriptions, networks) and analyze it to identify trends, patterns, and anomalies.
• Develop, build, and maintain reports, dashboards, and visualizations to track key performance indicators (KPIs) for leadership and management.
• Perform cost-benefit analysis and cost-effectiveness studies for various medications and treatment options, assessing the impact of benefit design changes.
• Assist with input of formulary and drug management requirements to data warehouse; oversight of formulary and drug management tables
• Ensure that pharmacy benefit programs comply with relevant healthcare regulations and assist with compliance reporting and audits.
• Provide data-driven recommendations for optimizing pharmacy benefit programs, including formulary management, prior authorization criteria, and cost-saving strategies.
• Partner with cross-functional teams to interpret data findings and implement recommended changes.
• Ensure the accuracy, integrity, and completeness of PBM data by implementing and monitoring data validation processes.
• Conduct ad-hoc data analysis and support special projects as needed to address evolving business needs.
• Communicate findings of data investigations and manage expectations for internal and external stakeholders.
• Maintains a thorough understanding of the data warehouse process, PBM contract requirements, reconciliations, vendor agreements, reporting applications and reporting requirements.
• Helps execute strategic vision for data warehouse enhancements/improvements to serve Analytics needs.
• Reviews and corresponds to vendor requests and inquiries for data transfer activities.
• Maintains a high level of professionalism and sense of urgency to ensure PBM expectations are consistently met.
• Reviews and completes financial sections of RFP/RFIs, market checks, and contract renewals and forecasts accurate cost assumptions into pricing offers.
• Sets goals and achieve measurable results.
• Contributes ideas to plans and achieving department goals.
• Exemplifies the Fund’s BETTER Values and professional effectiveness dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion.
• Performs other duties as assigned within the scope of responsibilities and requirements of the job.
• Performs Essential Job Functions and Duties with or without reasonable accommodation.

• 7~10 years or more years’ experience in data analytics, with a specific focus on PBM pharmacy data.
• 4+ years of experience working at a PBM
• Strong understanding of PBM operations, including benefit plan design, formulary management, claims adjudication, and eligibility processing.
• Experience working with data warehouses, large datasets, and structured/unstructured data sources.
• Strong understanding of PBM pharmacy claims data and healthcare analytics.
• Working knowledge of industry coding (revenue codes, International Classification of Diseases (ICD) 9 or 10’s, Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) codes, Medispan, etc.).
• Working knowledge of Formulary and Drug management concepts (Tiers, Prior Authorization, Quantity Limits, Step Therapy, etc.).
• Ability to format reports and explain results.
• Demonstrated ability to manage complex projects.
• Organizational and time management skills to prioritize workload and meet deadlines required.
• Must be results oriented with the ability to change priorities as needed.
• Excellent verbal and written communication, client-facing, and organizational skills.
• Familiarity with claims processing systems (e.g., RxCLAIM) and Medispan or First Databank).
• Proficiency with project management tools (e.g., MS Project, Jira, Smartsheet) and Microsoft Office Suite

Education, Licenses, and Certifications 

• A Bachelor's degree in a quantitative field such as Data Science, Statistics, or Health Policy.

Skills and Abilities 

• Advanced level Microsoft Office skills (PowerPoint, Word, Access, Outlook)
• Advanced level Microsoft Excel skills
• Advanced proficiency in writing complex and optimized SQL queries is essential.
• Advanced skills in data visualization tools like Tableau, Power BI, or Looker.
• Advanced level system(s) skills in SQL
• Knowledge of SAS, R, or Python for advanced data manipulation or statistical modeling.
• Experience with formulary coding options and pharmacy network configuration and claims adjudication.
• Knowledge of clinical drug information or manufacturer rebates preferred.
• Robust critical thinking and problem-solving abilities to interpret data and identify actionable insights.
• Excellent written and verbal communication skills to effectively present technical information and recommendations to various stakeholders.

• A strong understanding of the complexities of the pharmacy benefits industry, including data structures, common analytics, and healthcare regulations.
• Strong organizational, time management, project management, and interpersonal skills.
• Ability to work collaboratively with all levels of staff
• Ability to provide effective leadership
• Ability to manage multiple projects and priorities