About the Company

Organization: Rivera (Formerly HealthPlan Data Solutions, Inc)

Location: Columbus, Ohio

About the Role

The Clinical Pharmacist/Analyst is responsible for the critical analysis and interpretation of customer claims data to assess the customer’s plan performance, trends, savings opportunities, and to identify fraud, waste, and abuse (FWA). By combining clinical expertise, analytical capabilities, and deep understanding of PBM contracts and claims adjudication process, this role is crucial in ensuring the customer is strategically supported and optimizes the value of their pharmacy benefit. Additionally, the Clinical Pharmacist/Analyst supports the VP of Analytics and Product Development team with special projects.

Responsibilities

• Conducts extensive research and analysis of client claims data using analytical tools such as SQL and advanced Excel.
• Develops accurate summary reports and actionable plans based on data analysis.
• Supports all special projects assigned by VP of Analytics and Product Development, utilizing data visualization tools like Tableau or Power BI to present findings.
• Formally presents findings and supports recommendations to customers during Quarterly Business Reviews, using statistical analysis and predictive modeling to highlight key insights.
• Creates ad hoc custom queries for customers, leveraging data mining techniques to extract relevant information.
• Acts as subject matter expert on contract compliance and plan performance, using analytical frameworks to interpret complex contract terms and conditions.
• Stays current on regulatory and industry changes to ensure compliance and innovation.

Qualifications

• PharmD or RPh from an accredited college or university
• At least 5 years of progressive work experience in clinically oriented analysis role.
• At least 3 years’ experience with a PBM, MCO, or large self-insured employer preferred.
• Deep knowledge of the pharmaceutical industry, including relationships, agreements, pricing, treatment protocols, and therapeutic equivalents.

Required Skills

• Deep clinical pharmacy expertise, including Rx benefit plan design, drug classes, treatment protocols, and therapeutic equivalents.
• Demonstrated experience in clinical analytics, program design, and/or plan implementation.
• Strong research and analysis skills, with proficiency in data analysis software.
• Highly proficient with Microsoft Office suite, particularly Excel for data manipulation and analysis and PowerPoint for presentations.
• Willingness and capability to learn new concepts and tools, including advanced analytics platforms.
• Highly developed critical thinking skills, with the ability to apply quantitative methods to solve complex problems.
• Demonstrated ability to understand complex contract terms and conditions, using analytical reasoning.
• Strong results orientation, with a focus on data-driven decision-making.
• Outstanding organizational and prioritization skills, with the ability to manage multiple analytical projects.
• Strong presentation skills, with the ability to convey analytical findings to various audiences.
• Highly motivated self-starter with a commitment to continuous learning.

Preferred Skills

• Experience with advanced analytics platforms.
• Familiarity with data visualization tools.

Pay range and compensation package

Compensation details are not specified in the provided job description.

Equal Opportunity Statement

We are committed to diversity and inclusivity in our hiring practices.