Pharmacy Business Analyst

Provider Partners is seeking a Pharmacy Business Analyst for their Medicare Advantage Plan to analyze pharmacy data and support the development of pharmacy benefit strategies. The role involves collaborating with cross-functional teams to enhance operational efficiency and ensure compliance with regulatory requirements.

Responsibilities:

• Analyze pharmacy utilization patterns, claims data, and cost trends to identify opportunities for cost savings and improved patient outcomes
• Develop and maintain reporting tools, dashboards, and performance metrics to track key pharmacy business indicators
• Assist in the evaluation and optimization of the drug formulary to ensure cost-effective medication options are available to members
• Monitor drug utilization and perform therapeutic class reviews to support formulary decision-making
• Ensure adherence to CMS regulations and guidelines related to pharmacy benefits within the Medicare Advantage plan
• Collaborate with compliance teams to conduct audits and prepare necessary documentation for regulatory reviews
• Identify and analyze high-cost medications and utilization trends to develop strategies for managing pharmacy spend
• Support the negotiation and management of pharmacy network contracts with providers and pharmacy benefit managers (PBMs)
• Work closely with clinical teams, marketing, and member services to ensure cohesive communication of pharmacy benefits to members and providers
• Facilitate meetings with stakeholders to present findings, recommendations, and strategic initiatives
• Lead and support pharmacy-related projects aimed at enhancing operational efficiency and improving member health outcomes
• Track project progress, milestones, and outcomes, reporting on successes and areas for improvement

Requirements:

• Bachelor's degree in Pharmacy, Health Administration, Business Administration, or a related field
• Minimum of 3 years of experience in pharmacy benefits management, healthcare analytics, or a related field
• Strong analytical skills with proficiency in data analysis tools (e.g., Excel, SQL, or business intelligence software)
• Knowledge of pharmacy benefit structures, formulary management, and Medicare regulations
• Excellent communication and interpersonal skills, with the ability to collaborate across departments
• Detail-oriented with strong organizational and project management abilities
• A PharmD is preferred
• Experience working with Medicare Advantage plans is highly desirable
• Certification in pharmacy benefits management or healthcare analytics (e.g., CPBM, CPHQ) is a plus
• Familiarity with pharmacy management systems and electronic health records (EHRs)