Sr. Director, Pharmacy Network Informatics

Sr. Director, Pharmacy Network Informatics

Location: US-

Position ID:

Company: Navitus

Category: Health Strategies | Position Type: Full-Time | Remote: Yes

Pay Range: USD 147,648.00 – USD 184,559.00 per year

STAR Bonus: 17.50% (At Risk Maximum) – Sr Director

Work Schedule: M-F 8am to 5pm CT

Overview

Due to growth, we are adding a Sr. Director, Pharmacy Network Informatics to our team! The Sr. Director, Pharmacy Network Informatics will oversee, lead and provide strategic direction to the Navitus Network Pricing Team, Pharmacy Business Impact Analysts, Retail and Specialty Contract Analysts, Network Reporting Team, Business Impact Analyst, Reconciliation, Pharmacy Contract Performance, and the Navitus MAC Team to ensure the success of business needs, financial guarantee, and risk analysis. The Sr. Director will ensure collaboration, partnerships and support of the Navitus Provider Services, Sales, Account Management, Underwriting, Finance, and Government Programs departments. The Sr. Director will leverage emerging technologies and analytics to assist internal and external customers to make informed decisions to decrease Navitus's financial risk and increase Navitus's sales, technical advancements, and marketing opportunities, and will serve as the Provider Services primary subject matter expert on all existing and prospective clients and RFP responses.

Responsibilities

• Direct the adequacy and performance of Navitus' provider networks via data modeling, analysis, and reporting.
• Develop and oversee pharmacy business intelligence dashboards, reports, and analytics infrastructure.
• Partner with internal stakeholders such as Finance, Underwriting, Operations, Compliance, IT to align pharmacy performance metrics, forecasting, KPI’s with organizational goals.
• Lead and effectively manage all risk-based pharmacy performance projects to ensure proper reimbursement, risk mitigation management and forecasting to maintain contract compliance, communicating to stakeholders.
• Leverage large and complex datasets to model financial, clinical, and operational outcomes; translate findings into strategies that optimize benefit design and network performance.
• Effectively interpret data models to establish prospect and renewal pricing and forecast solutions to secure new/retained business.
• Support and advise senior leadership regarding provider agreements, MAC Program administration, and network pricing strategy for prospects and renewals.
• Collaborate and lead informatics key objectives with Provider Services team leads in areas such as retail and specialty contracting, pharmacy operations, and client pharmacy services support.
• Maintain and manage a competitive, market-leading MAC Program involving pharmacies, clients, vendors, and internal liaisons.
• Oversee monitoring and maintaining Navitus generic effective rate, cost-plus, and other contractual requirements and pharmacy pricing methodologies, facilitating adjustments in the adjudication system to meet contractual terms.
• Own applicable data sources and models, ensuring integrity. Sources include proprietary databases, PC2, Quest Analytics, Qlikview extracts, SQL, PAC, Medi-Span, HHSC, and CMS data files.
• Defend governmental and commercial reports in formal audits, identify validation techniques, and participate in full validation.
• Develop and maintain Policies and Procedures required by Navitus for all reports.
• Identify opportunities to maximize user self-service of pharmacy networks data, working with the Manager, Pharmacy Network Reporting to improve areas.
• Lead and inspire high-performing teams by providing strategic direction, aligning talent and resources, fostering cross-functional collaboration, and promoting continuous improvement.
• Other duties as assigned.

Qualifications

• Bachelor's degree in information systems, statistics, finance, actuarial sciences, business or equivalent work experience required. Additional work experience or courses in a health-related field, especially pharmacy benefit management, preferred.
• 10+ years' experience in healthcare economics or PBM analytics required.
• 10+ years' experience leading and developing multi-disciplinary teams required. Experience leading teams in PBM or managed care preferred.
• Demonstrated experience building and operationalizing Pharmacy Network Informatics structures, frameworks, and modeling tools required.
• Strong track record of leading processes and standard collaboration with external client-facing teams.
• 5+ years' experience leading informatics and developing data-driven analysis to drive pricing methodologies.
• Demonstrated ability to design long-term strategies to support business risk mitigation processes.
• Participate in, adhere to, and support compliance program objectives.
• Ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K with company match up to 5% – no vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program – up to $750!

#LI-Remote

Navitus is an equal employment opportunity employer. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

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