Sr. Director, Pharmacy Network Informatics

Navitus Health Solutions, LLC

2d•Remote

About The Position

Due to growth, we are adding a Sr. Director, Pharmacy Network Informatics to our team! The Sr. Director, Pharmacy Network Informatics will oversee, lead and provide strategic direction to the Navitus Network Pricing Team, Pharmacy Business Impact Analysts, Retail and Specialty Contract Analysts, Network Reporting Team, Business Impact Analyst, Reconciliation, Pharmacy Contract Performance, and the Navitus MAC Team to ensure the success of business needs, financial guarantee, and risk analysis. The Sr. Director will ensure collaboration, partnerships and support of the Navitus Provider Services, Sales, Account Management, Underwriting, Finance, and Government Programs departments The Sr. Director will leverage use of emerging technologies and analytics to assist internal and external customers to make informed decisions to decrease Navitus’ financial risk and increase Navitus’ sales, technical advancements, and marketing opportunities and will serve as the Provider Services primary subject matter expert on all existing and prospective clients and RFP response. Is this you? Find out more below!

Requirements

Bachelor’s degree in information systems, statistics, finance, actuarial sciences, or business or equivalent work experience required. Additional work experience and/or courses in a health-related field, especially pharmacy benefit management, preferred.
10 + years’ experience in healthcare economics or PBM analytics required.
10+ years’ experience leading and developing multi-disciplinary teams required. Experience leading teams in PBM or managed care preferred.
Demonstrated experience building and operationalizing Pharmacy Network Informatics structures, frameworks, and modeling tools required.
Strong track record of leading processes and standard collaboration with external client facing teams.
5+ years’ experience leading informatics and developing data driven analysis to drive pricing methodologies.
Demonstrated ability to design long-term strategies to support business risk mitigation processes.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

Direct the adequacy and performance of Navitus’ provider networks via data modeling, analysis, and reporting received from the team.
Develop and oversee pharmacy business intelligences dashboards, reports, and analytics infrastructure.
Partner with internal stakeholders such as Finance, Underwriting, Operations, Compliance, IT to align pharmacy performance metrics, forecasting, KPI’s with organizational goals.
Lead and effectively manage all risk based pharmacy performance projects to ensure proper reimbursement, risk mitigation management and forecasting to maintain contract compliance effectively communicating to internal and external stakeholders. Leverage large and complex datasets to model financial, clinical, and operational outcomes; translate findings into implementable strategies that optimize benefit design and network performance.
Effectively interpret data models to establish prospect and renewal pricing and forecast solutions to secure new/retained business.
Support and advise senior leadership regarding provider agreements, administration of the MAC Program, and network pricing strategy for prospects and renewals.
Collaborate and lead informatics key objectives with Provider Services team leads in areas including retail and specialty contracting, pharmacy operations, and client pharmacy services support.
Responsible for maintaining and managing a competitive, market leading MAC Program including working with pharmacies, clients, vendors, and internal department liaisons to implement and maintain a compliant MAC Program.
Main oversight for monitoring and maintaining Navitus generic effective rate, cost-plus, and other contractual requirements and pharmacy pricing methodologies with applicable providers and facilitating adjustments in Navitus’ adjudication system to meet contractual terms.
Ownership of applicable data sources and models, including limitations of use and processes to ensure and enhance integrity. Applicable data sources and models include but are not limited to proprietary internal databases, PC2, Quest Analytics, Qlikview extracts, SQL, PAC, Medi-Span, HHSC, and CMS data files.
Defend governmental and commercial reports as requested in formal audits with third party auditors. Identify meaningful report validation techniques and participate in full validation of audited reports.
Ownership of the development and maintenance of Policy and Procedures as required by Navitus for all reports requiring formal P&Ps.
Oversee and identify opportunities for maximizing user self-service of pharmacy networks data. Work with the Manager, Pharmacy Network Reporting to identify other areas for improvement. Build solutions using the best-fit technology to push information gathering out to the end user
Lead and inspire high-performing teams by providing strategic direction, aligning talent and resources with organizational goals to drive operational excellence, foster cross-functional collaboration, and promote a culture of continuous improvement across key business initiatives.
Other duties as assigned