Arizona PDL Health Data Analyst Senior - Remote

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Job Posting Title

Arizona PDL Health Data Analyst Senior - Remote

Job Description

The Arizona PDL Senior Health Data Analyst provides information, analyses, and consultation to internal and external stakeholders. This position assesses the performance of pharmacy benefits and/or networks and develops recommendations for improvements or enhancement to support departmental and organizational objectives. This position will develop new reports, analytical models, and products/benefit programs that align with Prime's strategic imperatives and will lead high-complexity analysis and special projects as required.

Responsibilities

• Act as a champion of the consulting and analytic methodology for designated line of business; may provide work direction, serve as a mentor or train junior level analysts
• Develop analytic methodologies, models, reports and new products
• Lead complex client analytical work efforts and serve as an internal subject matter expert in designated line of business; leverages deep understanding of client or organizational drivers and maintains final accountability for client analytics and ad hoc reporting
• Proactively investigates and builds recommendations for enhancements or resolution regarding key drivers of benefit performance, trends and obstacles in order to improve overall benefit and/or network performance and provide effective consultation to internal and external stakeholders
  
  

Additional Specific PDL Client Responsibilities

• PDL Compliance Evaluation:
• Evaluate data by Managed Care Organization (MCO) to ensure compliance with the Preferred Drug List (PDL).
• Identify plans that are not adhering to the PDL, whether intentionally or not, especially if brand P is seeing generic utilization. This is a goal for Arizona in 2025.
• Automate the compliance evaluation process.
• Familiarity with Arizona’s PDL Program: Develop a thorough understanding of Arizona’s Preferred Drug List program.
• Drug Status Reporting:
• Before finalizing decisions post Pharmacy and Therapeutics (P&T) committee review, generate reports showing all drugs changing statuses, including their Average Wholesale Price (AWP) and Wholesale Acquisition Cost (WAC).
• Arizona will finalize P&T decisions after reviewing National Drug Codes (NDCs). For example, if 15 out of 20 NDCs show a similar price range and 5 NDCs have excessive pricing, the report will help identify the 5 NDCs to exclude from preferred status.
• NDC Review and Fraud Prevention:
• Review all NDCs to find weighted averages of those not excessively priced.
• Ensure pharmacies purchase the least costly products and are not billing for NDCs that are not being used.
• By making certain NDCs non-preferred (NP), the goal is to eliminate potential Fraud, Waste, and Abuse (FWA).
• Savings Opportunities: Focus on creating savings opportunities through detailed analysis and reporting.
  
  

Education & Experience

• Bachelor's degree in Mathematics, Finance, or related field, or the equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 5 years of experience in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare, financial services or related field
  
  

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Desired Pharmacy Skills

• Pharmacy Benefit Management Experience: Experience in Pharmacy Benefit Management is advantageous.
• Business Knowledge of NCPDP Data: Proficiency in understanding and working with NCPDP data fields and elements.
• Experience with Managed Care Organizations (MCO) and Drug Reporting: Experience in handling MCO and drug reporting.
• Pharmacy Claims Data Evaluation: Ability to evaluate pharmacy claims data to produce reports for prescribers, MCOs, providers, and members.
• Pharmacy Data Expertise: Experience with pharmacy data, including NCPDP file formats and the differentiation between submitted versus paid ingredient costs.
• Account Management/Client Service: Experience in account management as this is a client facing role.
  
  

Additional Qualifications

• Advanced troubleshooting skills, including in-depth client data research, which may involve research and drivers of utilization; understands resources needed and steps/processes on how to complete the problem; when issue arises, able to understand how to navigate to a resolution
• Strong PBM industry knowledge and knowledge of the financial levers of Prime; able to articulate the industry trends to clients and the impact of trends and changes to client financials
• Ability to establish rapport and effectively influence at all levels within an organization
• Ability to communicate effectively and present complex data to a wide variety of audiences
  
  

Preferred Qualifications

• PBM (Pharmacy Benefit Management) experience
• Experience conducting complex analysis on large sets of pharmacy, claims, medical, and/or financial data
• Basic to intermediate SAS coding skills
• Previous experience in a client facing or consultative role
• Extensive experience using analytic tools; familiarity with SAS EG
  
  

Physical Demands

• Ability to travel up to 10% of the time
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
  
  

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

_Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   _

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.