Medical Informatics Analyst, Sr. Principal

Company: Blue Shield of California
Location: Oakland
Posted on: February 7, 2025

Job Description:

Your Role The Cost of Health Care Actuarial 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, Sr. Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team's strategic objectives in contract negotiations, pricing for self-funded employer groups, formulary changes, product development, and initiative evaluation.Your Work In this role, you will:

• Be an expert in specific vertical, such as Pharmacy, MediCal, Medicare, etc. and use your deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
• Lead the vendor financial contract performance evaluation, forecast and negotiation (e.g. rebates, network contracts)
• Develop the budget/trend impact models and formulary strategy models for high impact existing and pipeline drugs
• Provide Rx data analytics and lead with SVP in our product governance /value assessment committee on Rx benefit and formulary strategy
• Work and 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.
• Describe the significance of analytic results for business decision-making and makes recommendations to senior executives and external entities Your Knowledge and Experience
  • Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience.
  • PhD or MD strongly preferred.
  • Requires a minimum of 10 years of prior relevant experience
  • Requires 5 years' experience in Health Care (managed care, academic, or gov't payer)
  • Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
  • Requires experience at a Pharmacy Benefit Manager (PBM)
  • 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 Pay Range: The pay range for this role is: $ 176550.00 to $ 264880.00 for California. The pay range for this role is $160500.00 to $240800.00 for outside of California Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

Keywords: Blue Shield of California, Oakland , Medical Informatics Analyst, Sr. Principal, Healthcare , Oakland, California