Your Role
The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends. The Pharmacy Medical Informaticist, Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team's strategic objectives in contract negotiations, pricing for self-funded employer groups, formulary changes, product development, and initiative evaluation.
Your Work
In this role, you will:
- Use deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
- Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies
- Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts
- Communicate project status, progress, and outcomes to executive management
- Fulfill a leadership role in the critical review and ongoing development of data management and analytical systems for strategically important enterprise-wide analysis and reporting
- Support vendor financial contract performance evaluation, forecast and negotiation (e.g. rebates, network contracts)
- Support development of budget/trend impact models and formulary strategy models for high impact existing and pipeline drugs
- Provide Rx data support and participate in product governance /value assessment committee on Rx benefit and formulary strategy
- Support ASO product strategy evaluation and coordinate with UW and Actuarial Trend teams as needed
- Support RxCare strategic initiatives evaluation as needed
Your Knowledge and Experience
- Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
- Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
- Requires at least 10 years of prior relevant experience
- Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
- Requires experience at a Pharmacy Benefit Manager (PBM)
Pay Range:
The pay range for this role is: $ 145970.00 to $ 218900.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
