Lead PBM Network Analyst/Management

Job Title: Lead PBM Network Analyst/Management (Oversight of networks including specialty). This role supports the oversight and optimization of pharmacy network operations. Responsibilities include:

- Monitor key performance metrics such as claims volume, turnaround times, network adequacy, and member satisfaction.
- Support credentialing, re-contracting, and termination processes across all network pharmacy providers.
- Ensure alignment of network operations with contractual, regulatory, and service-level standards.
- Coordinate with internal stakeholders to address network performance concerns and ensure resolution.

PURPOSE:
Delivers critical and emerging systems and data analysis and implements tools and technology for the whole enterprise. Design, and deliver management systems. Build, manage, and sustain critical systems, business and data analysis techniques, methods, tools, and processes. Owns data collection capabilities through collaboration with internal and external teams. Leads cross-departmental, and cross-functional team members.

ESSENTIAL FUNCTIONS:
25% Performs complex system analyses on software programs, applications, and services.

20% Leads product and service evaluation and recommends new tools or platforms for user efficiency.

20% Leads the implementation of new technology for organizational efficiency.

15% Communicates directly with all stakeholders including executive management.

10% Improves data collection capabilities through collaboration with organizational teams.

10% Manages product licenses and ensures compliance with IT industry regulations. Provides the organization with cost cost-saving analysis.

- Experience: 8 years relevant systems/technical analysis
- Education Level: Bachelor's Degree - In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Top 5 Mandatory Skills:

1. Network performance analysis - Monitoring access, disruptions, trends, and service quality.
2. Provider relationship management - Engaging with pharmacy networks and resolving escalations.
3. Data-driven decision making - Using performance data to guide contracting, retention, and outreach.
4. Operational optimization - Driving improvements in network access, satisfaction, and cost efficiency.
5. Cross-functional collaboration - Coordinating with stakeholders across business, operations, and regulatory teams.