It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary :
Reporting to the Director of Clinical Pharmacy, the Clinical Pharmacy Analyst, is responsible for applying actuarial and statistical methods to analyze the financial performance of pharmacy-related healthcare programs and drug formularies. This role works at the intersection of clinical pharmacy, finance, and data analysis to support decision-making related to key performance indicators, drug formularies, member demographics, patient outcomes, and other relevant metrics. The incumbent will apply analytical acumen and a mastery of SAS and SQL, along with a sophisticated command of the Microsoft suite, enabling seamless data processing and dynamic presentation of insights. The position will work closely with actuaries, pharmacists, and healthcare providers to provide insights and recommendations for optimizing medication therapy management and cost control in healthcare plans.
Our Investment in You :
- Full-time remote work
- Competitive salaries
- Excellent benefits
Key Functions / Responsibilities :
Data Analysis & Reporting :
Analyze pharmacy claims data to identify trends in drug utilization, costs, and patient outcomes.Develop predictive models to forecast the financial impact of drug pricing, formularies, and clinical interventionConduct cost-benefit analysis on clinical initiatives and programWork with large data sets, using actuarial methods to assess financial risk and recommend adjustments to healthcare plans.Harness advanced tools such as Excel (including VBA), Python, or R to manipulate, analyze, and visualize data with precision and sophisticationPrepare regular reports on key performance indicators (KPIs), trends, and performance metrics.Support leadership in making data-driven decisions by providing insights and recommendations.Formulary management
Evaluate the financial and clinical impacts of drug formulary decisions.Collaborate with pharmacy benefit managers (PBMs) to assess and manage the cost of prescription drug plans.Analyze trends in drug pricing, reimbursement, and utilization to support formulary design and optimize cost savings.Identify high-cost medications or areas of inefficiency in formulary management.Process Improvement :
Analyze pharmacy workflows and identify opportunities for efficiency and process improvement.Develop and implement strategies to reduce drug waste, optimize inventory, and improve medication safety.Collaborate with cross-functional teams to implement new technologies or procedures.Regulatory Compliance
reportingEnsure pharmacy operations comply with regulatory requirements (NCQA etc).Monitor compliance with formulary management and medication policies.Stakeholder Collaboration :
Collaborate with clinical pharmacists, healthcare providers, and finance teams to analyze the financial impact of clinical interventions.Provide insights to healthcare plan sponsors on how to optimize pharmacy benefits while improving patient outcomes.Partner with finance teams to track healthcare costs and suggest cost-saving strategies.Deliver compelling presentations of findings and insights to internal stakeholders, effectively communicating complex concepts in a clear, concise, and persuasive manner using Utilize leading BI tools such as Tableau or Power BISupervision Exercised :
NoneSupervision Received :
General direction and supervision by Director of Clinical PharmacyQualifications :
Education Required : __
Bachelor’s degree in Actuarial Science, Pharmacy, Statistics, Mathematics, Healthcare Economics, or a related field.Education Preferred :
Advanced degree preferredExperience Required : __
2 years of experience in pharmacy operations, data analysis, or healthcare analytics.Experience Preferred / Desirable :
Experience in healthcare data analytics.Knowledge of regulatory requirements related to pharmacy operations.Familiarity with cost-management strategies in a healthcare settingRequired Licensure, Certification or Conditions of Employment :
Successful completion of pre-employment background checkCompetencies, Skills, and Attributes :
Strong analytical skills, with proficiency in statistical modeling and actuarial tools (e.g., Excel, SQL, R, SAS).Knowledge of pharmacy benefits management, healthcare reimbursement, and drug pricing.Familiarity with healthcare regulations and compliance, especially related to pharmacy services.Excellent communication skills, with the ability to present complex data and insights to both technical and non-technical audiences.Excellent written and oral communication skillsExcellent interpersonal skillsStrong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignmentsDemonstrated strength in analysis, identification of problems and issue resolutionExcellent skills in teamwork and team approaches to goal setting and attainmentMust be results orientedProficiency in standard computational office-suite applications, including word-processing and relational database manipulation is requiredWorking Conditions and Physical Effort
Regular and reliable attendance is an essential function of the position.Ability to work in a fast-paced environment.Work is normally performed in a typical remote, home-office work environment.No or very limited physical effort required. No or very limited exposure to physical risk.About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
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