Director, Network Informatics, Analytics

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Take ownership of and enhance the informatics framework that underpins pharmacy network contracting, encompassing contract attributes, reimbursement methods, network hierarchies, and provider identifiers.

• Establish and uphold data standards, definitions, and governance controls to guarantee data consistency, usability, and integrity across various systems and reporting environments.

• Act as the central authority for the quality of network and contract data, facilitating reliable and scalable analytics.

• Design and create network models to assess reimbursement structures, pricing strategies, and financial implications across pharmacy segments.

• Construct analytical frameworks to evaluate provider costs, performance, and value (e.g., scorecards, cost of care, network efficiency).

• Identify optimization opportunities through scenario modeling, trend analysis, and performance insights.

• Lead the creation and maintenance of standardized reporting and dashboards for network performance, reimbursement trends, and contract alignment.

• Provide actionable insights through regular and ad hoc analyses, including trend identification, outlier detection, and monitoring of emerging risks.

• Develop KPI frameworks to evaluate network effectiveness, cost efficiency, and overall performance across pharmacy segments.

• Establish and supervise analytical quality control frameworks to ensure alignment between contract intent and actual claims and network performance outcomes.

• Create monitoring strategies that reveal discrepancies, emerging risks, or unintended financial consequences.

• Supply analytical insights into the performance of new network developments, contract modifications, and reimbursement updates by evaluating claims outcomes and network performance.

• Collaborate with Analytics, Finance, IT, Compliance, Legal, and Operations to guarantee data transparency, alignment, and visibility into critical issues.

• Support enterprise initiatives such as new client implementations, regulatory changes, and strategies for network expansion.

⛳️ Requirements

• A Bachelor's degree in Business, Finance, Analytics, Information Systems, Healthcare Administration, or a related field, or equivalent work experience, is required.

• A minimum of 7 years of progressive experience in PBM, healthcare analytics, PBM network operations (excluding IT networks), pharmacy informatics, or similar experience is required.

• At least 3 years of leadership experience demonstrating the ability to cultivate high-performing teams and achieve tangible results in a professional services setting is required.

• Proven experience with claims data, network configuration, reimbursement models, and complex data environments is required.

• A demonstrated ability to lead analytics, reporting, or informatics functions within a regulated healthcare environment is required.

• Experience in supporting contracting, pricing, or network management functions is strongly preferred.

• Commitment to participate in, adhere to, and support compliance program objectives.

• The capacity to consistently engage cooperatively and respectfully with colleagues.

🏝️ Benefits

• Comprehensive industry-leading benefits for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and assistance with Professional Memberships.

• Referral Bonus Program – up to $750!