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Pharmacy Analytics Consultant I/IIExcellus Health Plan • Rochester, New York, United States
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Pharmacy Analytics Consultant I/II

Excellus Health Plan
  • US
    Rochester, New York, United States
  • US
    Rochester, New York, United States
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À propos

Pharmacy Analytics Consultant The Pharmacy Analytics Consultant provides direct support for both Pharmacy and Medical Drug information needs using a variety of analytic tools and applications. The Consultant will work with internal and external stakeholders and management, as required, to achieve Pharmacy Markets strategy, growth, compliance, and affordability objectives across the enterprise. The analyst collaborates with a multidisciplinary team (e.g., clinical, financial, sales, and Line of Business Leaders) to recommend actionable items leading to positive pharmacy financial performance. This position prepares and presents information to enable both senior management and our customers to better understand, evaluate, and support their goals. Essential Accountabilities: Level I
Perform research on projects and manage and lead projects to successfully meet business objectives from across the enterprise. Analyzes data to determine business problem, trends or opportunities for process improvements. Provide consultation and analytic support within the Pharmacy Division, other Health Plan departments and external vendors to ensure the most effective and affordable Pharmacy Benefit. Identify needs to develop new and innovative Pharmacy products, perform appropriate research, analyses, and evaluate feasibility of the administration and implementation of products. Communicate effectively with all levels of the organization related to, but not limited to, health plan cost, utilization trends and savings strategies. Articulate results, insights and recommendations to management, steering committees and/or project sponsors. Develop and deliver actionable insights to key enterprise stakeholders. Actively participating in collaborative meetings with internal and external partners. In partnership with Sales, Finance and Actuarial conduct comparative pricing analyses for pharmacy benefit Requests for Proposal. Provide analytics to support strategy development and innovative programs that align with enterprise and pharmacy goals and objectives. Partner with business units to ensure compliance with governmental, contractual, and corporate guidelines, regulations, and policies and procedures. Participate in all CMS and DOH compliance audits. Develop and establish standardized reporting and processes to support maintenance of business activities. Stay current with knowledge of Health Plans tools and data sources/structures to accurately pull and deliver data. Regularly review trends and best practices related to healthcare analytics Compiles complex data sets tailored to customers needs. Evaluates and processes raw data for user friendly and provides actionable insight (visual and otherwise) to end users. Consults with other specialized analytic units (i.e. Business Intelligence) to develop automated production reports, dashboards and cubes for efficiency when appropriate. Engage with external partners and customers (i.e. Employer Groups, Brokers, Consultants, Providers, and Vendors) to help drive the success of Health Plan partnerships and goals. Enhance Pharmacy knowledge and consulting skills to contribute to affordability and savings for the Enterprise and our customers. Creates unified strategies with internal departments that target reducing costs of healthcare. Manages, organizes and prioritizes tasks for multiple projects with competing deadlines to successful completion. Collaborates with team members, leveraging skill sets across the team and aiding in growth and development as needed. Proactively problem solves, investigates and brings forward concerns to management and/or business partners with relation to data pulls and analyses, as appropriate. Builds collaborative relationship across functional teams and other analytic teams across the organization. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management.
Level II (in addition to Level I Accountabilities)
Assists in training and mentoring fellow analysts. Participates and represents as a subject matter expert (SME) in cross-sectional team meetings or with business partner leads or other departments as needed. Participates on departmental and Health Plan project teams to recommends and/or develops comprehensive data strategies for optimal SAS/BI Tool utilization and connectivity with other BI tools. Devises strategy for producing deliverables, selecting and utilizing the most appropriate analytic tool, as well as, to begin to build process efficiencies.
Level III (in addition to Level II Accountabilities)
Utilizes all relevant and available tools that optimize reporting efficiency for consumption by business partners and/or provides the business partners the user-friendly tools to run repetitive reports self-service. Uses knowledge of both the claims data sets/warehouses available and the Medical/Pharmacy Management systems to produce reports that tie the information (claims plus health plan or vendor partner management) that illustrates the effectiveness of health plan and provider partner programs as they relate to trend, program development opportunities, value of management programs to be used both internally and externally. Contributes, in partnership with Data Science to develop predictive cost savings models (or other types of models) and to quantify the value and impact of the department management programs (program specific) for business use to both external and internal partners, ultimately helping to sell programs to employer groups, as needed. Provides expertise in relational database concepts to analytics areas, as well as, customers. Seeks out opportunities to train and mentor fellow analysts within the framework of the department. Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems.
Level IV (in addition to Level III Accountabilities)
Recommends to leadership advanced analytic models and/or research that financially impact pricing, cost containment, quality, marketing and risk management functions. Develops large, complex advanced analytic models and performs data mining functions to identify trends in the data and/or opportunities for improved outcomes, as appropriate. Provides consultation, complex performance analysis, and coaching expertise to team member around methods of continuous quality improvement. Fosters a culture of continuous improvement that includes the use of performance data to understand health care cost and utilization trends, clinical and condition management analysis, health care cost containment, data quality measurement, and predictive modeling. Improves visual analytics throughout the organization. Interacts with Health Plan leadership to interpret model output and make business inferences that address strategic needs. Assesses need and opportunity for upgrades to existing or new analytic products (i.e. SAS or Cognos products). Prepares and submits studies for journal publication or presentation at national meetings, as needed.
Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels
Bachelor's degree in Mathematics, Statistics, Medical Informatics, Economics, or related field preferred. In lieu of a degree, a minimum of two related years' experience in data or information analyses and reporting. Knowledge and applicable use of all tools available to develop analyses, extract information and using the most appropriate tool for the given report is required (i.e. SAS, Cognos, Excel, Access, SPSS, DataFlux, AQT, Winscp, puTTy etc.). Ability to approach data analysis with different data mining techniques, statistical techniques (when applicable). Proficient in using SAS and/or Cognos and Microsoft tools. Working knowledge of Microsoft Office Suite. Knowledge of basic statistical concepts and have strong analytical and problem-solving skills with attention to detail. Demonstrates the ability to take complex data sets and simplify for all audiences to understand through both visual interpretation and highlighting data points of significant impact or potential areas for impactful program development (quality of care and controlling costs). Willingness to develop relationships with partners within the health plan to both understand data requests and help to shape the request for more influential impact. Demonstrates intermediate understanding of healthcare products and operational business knowledge. Demonstrated analytic abilities combined with capabilities for completing projects with minimum degree of supervision. Knowledge of the health care system and experience working with physician or hospital claims/group data preferred. In depth knowledge of product and member desirable. Excellent oral and written communication skills with aptitude for communicating to a variety of audiences. High degree of initiative, proactive attitude and commitment to teamwork. Demonstrated ability to effectively and tactfully
  • Rochester, New York, United States

Compétences linguistiques

  • English
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