Director, Network Informatics & Analytics
About The Position
This is a strategic leadership role responsible for the data, informatics, analytics, and quality governance that support pharmacy network contracting across Chain, Specialty, and Independent/Affiliated networks. This role serves as the centralized owner of network and contract data integrity, analytics, reporting, and analytical validation of outcomes. This leader ensures that contract terms negotiated by Network Contracting are accurately represented in data and continuously assessed through analytics to provide insight into claims outcomes and network performance. In addition, this role will drive the development of advanced network models and analytical frameworks to evaluate reimbursement strategies, provider performance, and overall network cost effectiveness, enabling data-driven decision-making across the organization. The Director functions as a key strategic partner to Network Contracting leadership, providing actionable insights, predictive analytics, and proactive identification of risks and opportunities to optimize network performance and inform strategic decisions.
Requirements
- Bachelor’s degree in Business, Finance, Analytics, Information Systems, Healthcare Administration, or related field, or equivalent work experience, required.
- 7+ years of progressive experience in PBM, healthcare analytics, PBM network operations (not IT networks), pharmacy informatics or equivalent experience required.
- 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required.
- Demonstrated experience with claims data, network configuration, reimbursement models, and complex data environments required.
- Proven ability to lead analytics, reporting, or informatics functions in a regulated healthcare setting required.
- Participate in, adhere to, and support compliance program objectives.
- The ability to consistently interact cooperatively and respectfully with other employees.
Nice To Haves
- Experience supporting contracting, pricing, or network management functions strongly preferred.
Responsibilities
- Own and evolve the informatics framework supporting pharmacy network contracting, including contract attributes, reimbursement methodologies, network hierarchies, and provider identifiers
- Establish and maintain data standards, definitions, and governance controls to ensure data consistency, usability, and integrity across systems and reporting environments
- Serve as the centralized authority for network and contract data quality, enabling reliable and scalable analytics
- Design and develop network models to evaluate reimbursement structures, pricing strategies, and financial impact across pharmacy segments
- Build analytical frameworks to assess provider cost, performance, and value (e.g., scorecards, cost-of-care, network efficiency)
- Identify optimization opportunities through scenario modeling, trend analysis, and performance insights
- Partner with Finance, Actuarial, and Strategy teams to support forecasting, pricing decisions, and client-facing analytics
- Lead development and maintenance of standardized reporting and dashboards for network performance, reimbursement trends, and contract alignment
- Deliver actionable insights through routine and ad hoc analyses, including trend identification, outlier detection, and emerging risk monitoring
- Establish KPI frameworks to measure network effectiveness, cost efficiency, and overall performance across pharmacy segments
- Establish and oversee analytical quality control frameworks to assess alignment between contract intent and observed claims and network performance outcomes
- Develop monitoring approaches that surface discrepancies, emerging risks, or unintended financial impacts
- Perform root cause analysis and partner with cross-functional teams to inform resolution strategies (without direct ownership of execution)
- Provide analytical insight into the performance of new network builds, contract changes, and reimbursement updates through evaluation of claims outcomes and network performance
- Partner with Network Contracting and Provider Services Operations to support visibility into implementation outcomes and emerging trends
- Develop analytics and reporting that assess whether network design intent is reflected in observed performance
- Surface risks, anomalies, or unintended financial impacts resulting from network or contract changes
- Serve as a key analytics and informatics partner to Network Contracting leadership across all pharmacy segments
- Collaborate with Analytics, Finance, IT, Compliance, Legal, and Operations to ensure data transparency, alignment, and visibility into key issues
- Support enterprise initiatives including new client implementations, regulatory changes, and network expansion strategies
- Additional duties as assigned
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
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What This Job Offers
Job Type
Full-time
Career Level
Director
