Senior Policy Lead - Drug Pricing and PBM Data

MITRE; New Windsor (MD); On-site; USD 155,000 - 233,000; Full time

Job summary

MITRE, in its CMS Programs Division, seeks a senior analyst to apply health policy and PBM industry expertise to prescription drug pricing and data standards projects. You will work with multidisciplinary teams shaping policy, data architecture, and guidance for machine-readable pricing data and negotiated rates.

The role emphasizes translating complex payer and PBM business processes into practical requirements, ensuring regulatory alignment and meaningful data interoperability in federal

Qualifications

• Minimum 10 years of related experience with a Bachelor's degree; or 8 years with a Master's; or 5 years with a PhD.
• Significant healthcare industry experience with health plans, PBMs, or related ops.
• Demonstrated knowledge of prescription drug benefit administration and relationships among stakeholders.
• Experience with healthcare business operations such as PBM operations, contracting, vendor management, or claims.
• Ability to translate business, policy, and regulatory considerations into practical requirements.
• Strong written and verbal communication for technical and non-technical audiences.

Responsibilities

• Provide senior SME on health plan and PBM business models, operations, contracting practices, prescription drug benefit administration, and the regulatory and policy environment affecting payer-PBM relationships.
• Advise multidisciplinary teams developing policy, standards, data architecture, and implementation guidance for prescription drug pricing and negotiated-rate information, including information reported through machine-readable files.
• Translate complex payer and PBM business processes, contractual arrangements, data flows, and operational practices into clear business and functional requirements that inform data standards, architecture, and technical guidance.
• Assess proposed policy, data, and technical requirements for operational feasibility and practical utility, drawing on an understanding of how prescription drug pricing and contracting information is created, maintained, exchanged, and used in real-world payer and PBM environments.
• Evaluate which prescription drug pricing data elements and business concepts can be meaningfully standardized or abstracted across differing payer, PBM, pharmacy, and contracting arrangements; identify important limitations, exceptions, and potential implementation challenges.
• Communicate complex industry, operational, policy, and technical concepts to federal stakeholders and interdisciplinary teams through analyses, briefings, recommendations, and implementation guidance.

Skills

Health policy expertise

PBM knowledge

Data standards experience

Policy translation

Education

Bachelor's degree

Master's degree

PhD

Job description

MITRE, in its CMS Programs Division, seeks a senior analyst to apply health policy and PBM industry expertise to prescription drug pricing and data standards projects. You will work with multidisciplinary teams shaping policy, data architecture, and guidance for machine-readable pricing data and negotiated rates.

The role emphasizes translating complex payer and PBM business processes into practical requirements, ensuring regulatory alignment and meaningful data interoperability in federal