Medical Informatics Analyst, Sr. Principal
Apply NowCompany: Blue Shield Of California
Location: Oakland, CA 94601
Description:
Job Description
Your Role
The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends. The Pharmacy Medical Informaticist, Sr. Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team's strategic objectives in contract negotiations, pricing for self-funded employer groups, formulary changes, product development, and initiative evaluation.
Responsibilities
Your Work
In this role, you will:
Qualifications
Your Knowledge and Experience
Pay Range:
The pay range for this role is: $ 176550.00 to $ 264880.00 for California.
The pay range for this role is $160500.00 to $240800.00 for outside of California
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
Our Workplace Model:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Your Role
The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends. The Pharmacy Medical Informaticist, Sr. Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team's strategic objectives in contract negotiations, pricing for self-funded employer groups, formulary changes, product development, and initiative evaluation.
Responsibilities
Your Work
In this role, you will:
- Be an expert in specific vertical, such as Pharmacy, MediCal, Medicare, etc. and use your deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
- Lead the vendor financial contract performance evaluation, forecast and negotiation (e.g. rebates, network contracts)
- Develop the budget/trend impact models and formulary strategy models for high impact existing and pipeline drugs
- Provide Rx data analytics and lead with SVP in our product governance /value assessment committee on Rx benefit and formulary strategy
- Work and lead in ASO product strategy evaluation and coordinate with UW and Actuarial Trend teams as needed
- Lead RxCare strategic initiatives evaluation as needed
- Be the strategic implementer and driver of revenue in their respective area of expertise.
- Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies.
- Describe the significance of analytic results for business decision-making and makes recommendations to senior executives and external entities
Qualifications
Your Knowledge and Experience
- Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience.
- PhD or MD strongly preferred.
- Requires a minimum of 10 years of prior relevant experience
- Requires 5 years' experience in Health Care (managed care, academic, or gov't payer)
- Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
- Requires experience at a Pharmacy Benefit Manager (PBM)
- Requires expertise in pharmacy benefit manager operations and pricing
- Requires expertise in pharmacy rebate and network dynamics to enable financial and pricing modeling
- Requires strong verbal and communication skills
Pay Range:
The pay range for this role is: $ 176550.00 to $ 264880.00 for California.
The pay range for this role is $160500.00 to $240800.00 for outside of California
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
- Member-facing and approved out-of-state roles remain remote.
- Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.