Clinical Pharmacist/Analyst

Main Purpose of Job: The Clinical Pharmacist/Analyst is responsible for the critical analysis and interpretation of customer claims data to assess the customers plan performance, trends, savings opportunities, and to identify fraud, waste, and abuse (FWA). By combining clinical expertise, analytical capabilities, and deep understanding of PBM contracts and claims adjudication process, this role is crucial in ensuring the customer is strategically supported and optimizes the value of their pharmacy benefit. Additionally, the Clinical Pharmacist/Analyst supports the VP of Analytics and Product Development team with special projects.

Key Duties and Responsibilities:

• Conducts extensive research and analysis of client claims data using analytical tools such as SQL, and Excel.
• Develops accurate summary reports and actionable plans based on data analysis.
• Supports all special projects assigned by VP of Analytics and Product Development, utilizing data visualization tools like Tableau or Power BI to present findings.
• Formally presents findings to customers during Quarterly Business Reviews, using statistical analysis and predictive modeling to highlight key insights.
• Creates ad hoc custom queries for customers, leveraging data mining techniques to extract relevant information.
• Acts as subject matter expert on contract compliance and plan performance, using analytical frameworks to interpret complex contract terms and conditions.

Required Skills, Knowledge, and Attributes:

• Deep clinical pharmacy expertise, including drug classes, treatment protocols, and therapeutic equivalents.
• Strong research and analysis skills, with proficiency in data analysis software.
• Highly proficient with Microsoft Office suite, particularly Excel for data manipulation and analysis.
• Willingness and capability to learn new concepts and tools, including advanced analytics platforms.
• Highly developed critical thinking skills, with the ability to apply quantitative methods to solve complex problems.
• Demonstrated ability to understand complex contract terms and conditions, using analytical reasoning.
• Strong results orientation, with a focus on data-driven decision-making.
• Outstanding organizational and prioritization skills, with the ability to manage multiple analytical projects.
• Strong presentation skills, with the ability to convey analytical findings to various audiences.
• Highly motivated self starter with a commitment to continuous learning.

Required Background:

• PharmD or RPh from an accredited college or university
• At least 5 years of progressive work experience in clinically oriented analysis role.
• At least 3 years experience with a health plan, managed care pharmacy, or large self-insured employer preferred.
• Deep knowledge of the pharmaceutical industry, including relationships, agreements, pricing, treatment protocols, and therapeutic equivalents.