Navitus Health Solutions
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Specialty Pharmacy Network Analyst II
at Navitus Health Solutions
LocationMadison Campus: Madison, Wisconsin
QUALIFICATIONS AND EXPERIENCE:
- BA/BS required. Educational concentration in business, finance, information systems or statistics preferred.
- At least 5 years of experience in a related health care environment (PBM, Health Plan, or Health System, etc.) or at least five years of experience as a data analyst is highly preferred.
- Experience with Microsoft Excel and Access and SQL or equivalent programming is preferred
- Ability to analyze and interpret data and exercise appropriate judgement is required
- Understanding of legal terms and government regulations desired
- Understanding of pharmacy claims schemes and medical industry standards desired
POSITION OVERVIEW AND PURPOSE:
The Specialty Pharmacy Network Analyst II, under the direction and supervision of Provider Services leadership,is responsible for assimilating multiple and disparate databases including claims utilization data, pharmacy provider data and industry market intelligence in order to deliver financial analysis, network trends and forecasting in support of the Specialty Pharmacy and Provider Services team. This position will also provide support of pharmacy programs to internal and external stakeholders through analysis of current and projected trends.
The Specialty Pharmacy Network Analyst II supports the Specialty Pharmacy team, Provider Services department and other internal teams through analysis and interpretation of channel and drug utilization and the current and projected pharmacy market. The position's primary responsibility is to analyze current and historical data to forecast market trends and identify opportunities to optimize pharmacy networks. Other responsibilities include network savings analyses, contract performance, opportunity analyses and reporting. The individual will be expected to understand and interpret data, including claims utilization from Navitus' data warehouse and from NCRx, formulary files, pharmacy network databases, NCPDP pharmacy files, Medispan files, medical claims files and other databases required from time-to-time to facilitate successful delivery of information for internal decision making and supporting customers' data reporting requirements. Provider and network performance will be analyzed in support of network development, contracting negotiations, and sales proposals. The Specialty Pharmacy Network Analyst II is responsible for the development of analytical models to manage financial risk. This position will also support the development of specialty medical services programs.
This position is responsible for ensuring the timely, consistent, and accurate analysis of historical and current utilization used to generate multiple outputs including trends/forecasting, savings analysis, channel optimization, and quality reporting. This position requires independent judgment and regularly exercises discretionary powers.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Proactive and ongoing analysis of historical and current utilization, network contracts, and market intelligence to create methodology and reporting mechanism for trend forecasting in support of contractual terms, channel development, new programs and sales.
- Proactive and ongoing analysis of medical claims data, development and maintenance of crosswalks between medical and pharmacy data
- Continuously review and pro-actively identify areas of opportunities for pricing and discount performance improvement via analysis of both sales and current client data.
- Coordination with internal and external teams in the development and maintenance of medical management programs, including systems and process development and reporting.
- Periodic and detailed reporting of activities and opportunities to Provider Services and Navitus leadership teams.
- Research external and internal pricing trends and opportunities to contribute to overall pricing strategy.
- Perform pharmacy analyses as requested by internal and external business owners, or in support of identified business objectives
- Responsible for development and maintenance of utilization and contractual data and the synthesis of data to generate scheduled and ad hoc financial reports for internal and external stakeholders
- Assist in data analysis for quality reporting and improvement projects.
- Responsible for analysis of contracts and maintenance of current pricing through coordination with internal departments
- Responsible for the use of databases to generate reports for clients, pharmacies, and internal customers and identification of ways to improve and/or automate generation of these reports
- Identify, advocate, and implement continual process improvement of policies and procedures to maximize quality and efficiencies.
- Manage projects for multiple teams within Provider Services department
- Other related duties as assigned.