Informatics nurse Jobs in Los Angeles, CA

Job Profile Summary
The Senior Healthcare Informatics Analyst – Pharmacy Analytics independently provides advanced analytics to support understanding and improvement of pharmacy benefit utilization, cost, quality, and clinical outcomes. This role develops analytic attributes related to pharmacy utilization management, drug cost optimization, formulary performance, medication adherence, and provider/member pharmacy engagement.
In collaboration with Pharmacy, Clinical, Actuarial, Finance, and IT partners, this position leads complex problem solving, solution development, and data?driven strategic decision making. Accountable for compliance with all applicable laws and regulations associated with pharmacy data and analytics responsibilities.

POSITION PURPOSE
The Senior Healthcare Informatics Analyst – Pharmacy Analytics independently designs and delivers analytics that improve how pharmacy services are valued, utilized, and provided. This role develops patient? and provider?level analytics including pharmacy utilization and outcomes, medication adherence and persistence, formulary and rebate optimization, pharmacy cost management, and pharmacy?driven quality measures.
The analyst supports enterprise initiatives across Pharmacy Operations, Medical Management, Actuarial, and Clinical teams, serving as a subject matter expert in pharmacy analytics and translating complex business questions into actionable insights.

NATURE AND SCOPE

This role does not manage people.

Necessary Contacts:
To effectively fulfill this position, the incumbent will collaborate with Pharmacy Operations, PBM partners, Clinical Solutions, Actuarial, Provider Reimbursement, Payment Innovation, IT, Marketing, external vendors, the Client Cross Association, PBMs, and other Client plan partners.

QUALIFICATIONS
Education

Bachelor’s degree in healthcare administration, pharmacy, public health, statistics, economics, analytics, computer science, or related field required Master’s degree in a related field preferred Four years of related experience may substitute for a Bachelor’s degree

Work Experience

years of healthcare analytics experience, with pharmacy or PBM analytics experience strongly preferred Experience analyzing pharmacy claims, formulary performance, drug mix, utilization trends, rebates, and adherence metrics (PDC/MPR) A Master’s degree may substitute for two years of required experience; a Doctorate may substitute for an additional two years


Skills and Abilities

Strong critical thinking, analytical, and problem?solving skills Experience building predictive and explanatory models related to pharmacy utilization, cost, and outcomes Knowledge of pharmacy outcomes research, utilization management, and drug trend analysis preferred Advanced knowledge of SAS (including Enterprise Miner) preferred Strong working knowledge of the healthcare system in a payer setting, with specific understanding of pharmacy benefits and PBM operations

Technical Skills:

Proficiency with SQL, SAS, R, Python, Tableau, or similar analytic/visualization tools

Domain Expertise (Desired):


Pharmacy pricing and payment methodologies (AWP, WAC, MAC, rebates, trend drivers)


Population health and pharmacy?driven interventions


Risk adjustment concepts and pharmacy’s role in total cost of care


Clinical groupers and classification systems including GPI, NDC, therapeutic class, DRG, HCC, and related models


Pharmacy?related quality metrics (HEDIS medication measures, STAR ratings)


Knowledge of commercial and Medicare Advantage pharmacy optimization is a plus


Excellent verbal and written communication skills


Ability to translate complex pharmacy analytics into clear insights for executive, clinical, and technical audiences



Licenses and Certifications

None required


ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

Leads the selection and application of pharmacy?focused analytic, evaluation, and BI methodologies to support business decisions and strategic planning Leverages pharmacy claims data, PBM feeds, EDW data sources, and non?EDW datasets to deliver actionable insights Independently partners with business teams to define pharmacy analytics needs and develop solutions such as predictive models, dashboards, utilization analyses, and performance metrics Serves as a pharmacy analytics advisor on enterprise and cross?functional initiatives Translates pharmacy business rules and policies into analytical models and reporting solutions, acting as a liaison between Pharmacy, Analytics, IT, and EIM teams Performs peer data quality reviews to ensure accuracy, completeness, and consistency of pharmacy analytics output Conducts advanced descriptive and statistical analyses related to drug utilization, adherence, cost drivers, and clinical outcomes


Additional Accountabilities and Essential Functions The physical demands described here are representative of those that must be met to successfully perform job functions. Reasonable accommodations may be made.

Performs other job?related duties as assigned within scope of responsibility Work is performed in a standard office environment with normal noise levels Work is primarily sedentary (standing or sitting) Ability to comprehend, document, calculate, visualize, and analyze complex data is required

EEO:

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