Pharmacy Pricing and Analytics, Sr. Principal

2 days ago

Oakland, California, United States Blue Shield of California Full time $123,000 - $200,000 per year
Description

Your Role

The Pharmacy Analytics & Finance 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, Senior Principal will report to the Senior Director, Actuarial Management and support the Pharmacy Team's strategic objectives in contract negotiations, pricing for self-funded employer groups, formulary changes, product development, and initiative evaluation.

Responsibilities

Your Work 

In this role, you will: 

  • Provide Rx data analytics and lead in our product governance /value assessment committee on Rx benefit and formulary strategy
  • Lead in ASO product strategy evaluation and coordinate with UW and Actuarial Trend teams as needed
  • Lead RxCare strategic initiatives evaluation as needed
  • Be the strategic implementer and driver of revenue in their respective area of expertise.
  • Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies.
  • Interpret analytic results for business decision-making and makes recommendations to senior executives and external entities
  • Revenue Management – Oversee and optimize revenue strategies for ASO book to ensure financial accuracy and transparency.
  • ASO Pricing Strategies – Develop and implement pricing strategies for Administrative Services Only (ASO) to drive growth in ASO line of business.
  • ASO Pricing Consultant Strategies – Provide expert guidance and support to ASO team in addressing consultant questions and messaging in the market.
  • Guarantee Tracking/Pricing Database – Maintain and enhance guarantee tracking systems and pricing databases for accuracy and compliance.
  • Competitive Intelligence – Monitor market trends and competitor strategies to inform pricing, formulary, and product development decisions.
Qualifications

Your Knowledge and Experience 

  • Requires a BA/BS in Finance, Actuarial, Data Science, Mathematics or related field with demonstrated equivalent work experience 
  • Requires a minimum of 10 years of prior relevant experience 
  • Requires 5 years' experience in Health Care (managed care, academic, or gov't payer) or with a Pharmacy Benefit Manager (PBM) or Pharmacy benefit consulting houses 
  • Requires data analytics tool expertise for both SAS and excel  
  • Requires expertise in pharmacy benefit manager operations and pricing  
  • Requires expertise in pharmacy rebate and network dynamics to enable financial and pricing modeling  
  • Requires strong verbal and communication skills 
  • Prefer candidates to have an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business. 
  • Requires understanding of a dynamic environment in the pharmacy space given the strategic move away from relying on pharmacy benefit managers to modular solution and away from pharmacy rebates to "net cost" approaches
  • Requires expert knowledge in PowerPoint, Word, Excel with strong verbal communication and collaboration skills

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