Clinical Pharmacy Informatics Lead

Mass General Brigham•Somerville, MA

4d•Remote

About The Position

The Clinical Pharmacy Informatics Lead is responsible for the day-to-day management, configuration, and optimization of clinical pharmacy systems and data that support the health plan’s pharmacy benefit across all lines of business. This role operates at the intersection of Clinical Pharmacy, Pharmacy Operations, IT, Finance, Compliance, Quality, and Enterprise Analytics to ensure systems accurately translate clinical intent into operational workflows, claims adjudication, and analytics that drive business objectives. This position leads the implementation and ongoing maintenance of clinical pharmacy operations, including formulary and utilization management builds, clinical edits, benefit structures, and drug coverage logic within core platforms. The Clinical Pharmacy Informatics Lead performs oversight of vendors (via testing and ROI evaluation support, validates system performance, troubleshoots issues, and ensures alignment between benefit design, utilization management policy, and adjudication outcomes. The role is accountable for data integrity and serves as a primary resource for identifying claims, authorization, and eligibility discrepancies that may impact member experience, provider abrasion, or reporting accuracy. A core responsibility of this role is generating actionable insights for leadership. The Lead collaborates with internal partners to identify, extract, and analyze pharmacy-related data. Working closely with analytics, quality, finance, and compliance teams, the Lead defines business requirements, interprets clinical and operational needs, validates data outputs, and communicates findings. The Clinical Pharmacy Informatics Lead plays a critical role in audit readiness by ensuring system logic, configuration documentation, testing evidence, and data traceability support CMS, state, and accreditation requirements. The role partners in audit preparation, supports universes and record validation, and assists with remediation and corrective action activities. This position also supports Stars, HEDIS, and other quality initiatives by enabling accurate identification of target populations, validating measure logic, and ensuring pharmacy data feeds and reports are complete, timely, and defensible. Additionally, the lead contributes to financial and utilization trend reporting, supporting rebate operations, budget forecasting, drug spend analysis, and identification of cost-of-care opportunities. The Clinical Pharmacy Informatics Lead identifies opportunities for automation and process improvement, contributes to SOP development, and provides subject matter expertise for system enhancements, upgrades, and vendor implementations. Success in this role requires strong technical aptitude, deep understanding of the pharmacy benefit, and the ability to convert complex cross-functional requirements into practical system and data solutions.

Requirements

Bachelor's Degree required and Master's Degree preferred
Active and good-standing Pharmacist license required
At least 5-7 years of experience in clinical informatics required
Authority-level knowledge of clinical operations and related business processes.
Excellent leadership and supervisory skills.
Excellent problem-solving and organizational skills.
Proficient with standard office technologies and software.
Strategic and able to quickly understand and discuss situations and challenges.

Responsibilities

Day-to-day management, configuration, and optimization of clinical pharmacy systems and data.
Leads the implementation and ongoing maintenance of clinical pharmacy operations.
Performs oversight of vendors.
Accountable for data integrity.
Generating actionable insights for leadership.
Plays a critical role in audit readiness.
Supports Stars, HEDIS, and other quality initiatives.
Contributes to financial and utilization trend reporting.
Identifies opportunities for automation and process improvement.
Contributes to SOP development.
Provides subject matter expertise for system enhancements, upgrades, and vendor implementations.