Clinical Pharmacist Analyst

Healthplan Data Solutions Inc.; Kentucky; Hybrid; USD 80,000 - 110,000; Full time

Job summary

Healthplan Data Solutions Inc. is seeking a Clinical Pharmacist/Analyst in Kentucky to analyze customer claims data, assess plan performance, and identify opportunities for savings and compliance. The ideal candidate has a PharmD and 5+ years in a clinical analysis role, specifically in pharmacy benefits management.

The position will involve extensive data research and analytics, presentation of findings to clients, and working collaboratively in a hybrid environment. Strong analytical and communication skills are a must.

Qualifications

• PharmD or RPh degree required.
• Minimum 5 years of progressive work experience in clinical analysis.
• Strong clinical pharmacy knowledge.

Responsibilities

• Analyze client claims data using SQL and Excel.
• Develop summary reports and actionable plans.
• Utilize data visualization tools for presentations.

Skills

Clinical pharmacy expertise

Data analysis skills

Research and analysis skills

Presentation skills

Critical thinking skills

Data-driven decision-making

Education

PharmD or RPh from an accredited college

Tools

SQL

Excel

Tableau

Power BI

Job description

Main Purpose of Job

The Clinical Pharmacist/Analyst is responsible for the critical analysis and interpretation of customer claims data to assess the customer’s 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 advanced 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 and supports recommendations 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.
• Stays current on regulatory and industry changes to ensure compliance and innovation.

Required Skills, Knowledge, and Attributes

• Deep clinical pharmacy expertise, including Rx benefit plan design, drug classes, treatment protocols, and therapeutic equivalents.
• Demonstrated experience in clinical analytics, program design, and/or plan implementation.
• Strong research and analysis skills, with proficiency in data analysis software.
• Highly proficient with Microsoft Office suite, particularly Excel for data manipulation and analysis and PowerPoint for presentations.
• 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 a clinically oriented analysis role.
• At least 3 years’ experience with a PBM, MCO, or large self-insured employer preferred.
• Deep knowledge of the pharmaceutical industry, including relationships, agreements, pricing, treatment protocols, and therapeutic equivalents.

Work Location

Strong preference will be given to Columbus, Ohio area candidates who are willing to work in a hybrid environment.