Director, Pharmacy AnalyticsSmartLight Analytics • PLANO, TX, US
Director, Pharmacy Analytics
SmartLight Analytics • PLANO, TX, US
30+ days ago
Job type
- Full-time
- Quick Apply
Job descriptionLeadership and Strategy : Develop and execute the strategic direction for pharmacy operations within the company, with a focus on improving payment integrity and optimizing reimbursement accuracy to assist self-funded employers effectively manage their plans. Lead, mentor and develop a team of pharmacy professionals, pharmacy analysts, and operational staff to ensure alignment with organizational objectives. Work closely with senior leadership to shape the vision and goals for pharmacy-related payment integrity initiatives. Pharmacy Payment Integrity and Claims Management : Utilize analytics to identify potential payment errors, overpayments, underpayments, and fraud within the pharmacy reimbursement cycle. Develop and implement solutions to reduce costs for clients in relation to pharmacy claims processing. Optimize PBM Rebate programs and incentives to benefit clients Review and recommend improvements to ASO PBM Contracts Data Analytics and Reporting : Work with the data analytics team to develop and implement AI models and algorithms that identify trends, discrepancies, and opportunities for improving pharmacy payment integrity. Use advanced analytics tools (e.g., AI / ML, business intelligence platforms) to analyze pharmacy claims data, detect anomalies, and recommend actionable solutions. Develop and present comprehensive reports to leadership, stakeholders, and external partners detailing performance metrics, insights, and recommendations. Regulatory Compliance and Industry Standards : Stay up to date with evolving healthcare regulations, pharmacy industry standards, and payer requirements to ensure compliance in all pharmacy-related processes. Ensure that pharmacy payment integrity initiatives align with government regulations (e.g., CMS, HIPAA), payer contracts, and industry standards. Qualifications : Education : PharmD, with a Managed Care Residency preferred Experience : Minimum of 6 – 8 years of experience in pharmacy operations, healthcare payment integrity, or pharmacy benefit management (PBM), with at least 3 years in a leadership role. Strong expertise in pharmacy claims auditing, payment integrity processes, and fraud detection. Experience with pharmacy reimbursement models, pharmacy compliance, and healthcare regulatory frameworks (e.g., CMS, HIPAA). Background in using data analytics or business intelligence tools to enhance pharmacy claims management and payment integrity. Skills : Strong leadership, team building, and management skills. Advanced knowledge of pharmacy benefits, payment integrity, claims adjudication, and fraud prevention. Excellent problem-solving, critical thinking, and strategic planning abilities. Strong communication skills with the ability to present complex data and insights to both technical and non-technical stakeholders. Key Competencies : Strong analytical mindset with the ability to identify patterns, trends, and anomalies in pharmacy data. Ability to drive change and implement process improvements based on data insights. Excellent interpersonal and communication skills, with the ability to work with cross-functional teams and external partners. High attention to detail and a commitment to quality and compliance. A proactive, solution-oriented approach to addressing challenges and improving operational efficiency. Who is SmartLight Analytics SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce the wasteful spend in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes. Powered by JazzHR
Job Title :
- Director of Pharmacy Analytics Location : Remote / Hybrid Department : Pharmacy / Payment Integrity Reports To : VP of Payment Integrity Job Summary : The Director of Pharmacy will lead the pharmacy-related functions within SmartLight Analytics.
- This leadership role will focus on ensuring the accuracy, efficiency, and compliance of pharmacy claims processing, with a particular emphasis on identifying and preventing fraud, waste, and abuse (FWA) using advanced analytics.
The Director will collaborate with cross-functional teams, including analytics, operations, technology, to develop and implement pharmacy strategies that optimize payment integrity, reduce costs, and enhance overall performance. This position will also involve overseeing the design, development, and execution of pharmacy programs that support payer and provider partnerships, while building and developing pharmacy team. Key Responsibilities :
Create a job alert for this search
Director Pharmacy • PLANO, TX, US
Related jobs
RAPP Dallas is looking for a Director, Analytics Enablement to join our award-winning Marketing Sciences team.We are RAPP - world leaders in activating growth with precision and empathy at scale.As...Show more
When you're the best, we're the best.We instill an environment where employees feel engaged, satisfied and able to contribute their unique skills and talents.
We provide extensive opportunities for ...Show more
DataBank's managed data center services are anchored in world-class facilities.Our customized technology solutions are designed to help customers effectively manage risk, improve technology perform...Show more
The Director, Operations, is responsible for leading and driving an efficient, compliant, cost-effective commercial laboratory operations.
The Director is responsible for the management of the diagn...Show more
Ready to Launch Your Career as an APP in Dermatology?.Are you a Nurse Practitioner or Physician Assistant looking to specialize in a field that’s rewarding, hands-on, and highly in demand?.De...Show more
DataBank's managed data center services are anchored in world-class facilities.Our customized technology solutions are designed to help customers effectively manage risk, improve technology perform...Show more
WHEN YOU WORK FOR US, WE WORK FOR YOU\n.With Titan Medical, you gain access to thousands of travel nursing and allied health jobs across the country.
You also get unmatched service.From the moment y...Show more
The Quality Assurance Manager is responsible for directing and managing the activities of the US quality assurance function in a manner that ensures all incoming materials, the production process, ...Show more
Prism Health North Texas is a leading Federally Qualified Health Center Look-Alike serving just under 20,000 patients annually across five sites in Dallas, Texas with a team of 30+ medical provider...Show more
We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...Show more
LocumJobsOnline is working with CompHealth to find a qualified Dermatology MD in McKinney, Texas, 75071!.CompHealth exists to make the locums process easier.
Not only will we search for jobs that fi...Show more
LocumJobsNetwork is working with CompHealth to find a qualified Dermatology MD in McKinney, Texas, 75071!.CompHealth exists to make the locums process easier.
Not only will we search for jobs that f...Show more
McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...Show more
McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...Show more McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...Show more 
Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers.We serve more than 750 payers, including the top five national health plans, regional hea...Show more
Dir Strategic Initiatives is responsible for strategic planning for Baylor Scott and White Health (BSWH), which may include establishing organizational objectives, developing long-range plans, incr...Show more
Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities.Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empo...Show more
Director, Analytics Enablement
RAPP • Dallas, TX, United States
Full-time
Last updated: 30+ days ago • Promoted
Director, Contract Services - Pharmacy
Vizient, Inc. • Irving, TX, United States
Full-time
Last updated: 30+ days ago • Promoted
Director of AI & Data Analytics
DataBank Holdings, Ltd. • Dallas, TX, United States
Full-time
Last updated: 9 days ago • Promoted
Director, Operations - Plano, TX
MDxHealth • Plano, TX, US
Full-time
Last updated: 26 days ago • Promoted
Learn Derm -Immersive Dermatology Training Program for NPs & PAs
Epiphany Dermatology • Forney, TX, US
Full-time
Last updated: 21 hours ago • Promoted • New!
Director of AI & Data Analytics
DataBank Holdings • Dallas, Texas, United States, 75202
Full-time
Last updated: 9 days ago
Travel - X-Ray Tech
Titan Medical Group • Princeton, TX, US
Full-time
Last updated: 1 day ago • Promoted
Quality Manager, Product Conformity
Recaro Aircraft Seating Americas, Inc. • Fate, TX, US
Full-time
Last updated: 1 day ago • Promoted
340B Network Pharmacy Director
Prism Health North Texas • Dallas, TX, US
Full-time
Last updated: 30+ days ago • Promoted
Remote Finance Director - AI Trainer ($50-$60 / hour)
Data Annotation • McKinney, Texas
Remote
Full-time +1
Last updated: 11 days ago • Promoted
Locum Physician (MD / DO) - Dermatology in McKinney, TX
LocumJobsOnline • McKinney, TX, US
Full-time +1
Last updated: 30+ days ago • Promoted
Locum Physician (MD / DO) - Dermatology in McKinney, TX
LocumJobsNetwork • McKinney, TX, US
Full-time +1
Last updated: 30+ days ago • Promoted
Director, Business Insights (Healthcare)
McKesson • Irving, TX, US
Full-time
Last updated: 14 days ago • Promoted
Sr. Director, Provider Solutions - Product & Partnerships
MCKESSON • Irving, TX, United States
Full-time
Last updated: 5 days ago • Promoted
Pricing Business Systems Liaison (Pharma) (Remote)
MCKESSON • Irving, TX, United States
Remote
Full-time
Last updated: 30+ days ago • Promoted
Director - Analytics & AI Enablement
Zelis Healthcare, LLC • Plano, TX, United States
Full-time
Last updated: 30+ days ago • Promoted
Director Strategic Initiatives Laboratory
Baylor University Medical Center • Dallas, TX, US
Full-time
Last updated: 8 days ago • Promoted
Director of Palliative Care – Baylor Scott & White Medical Center - McKinney
Baylor Scott & White Health • McKinney, US
Full-time
Last updated: 30+ days ago • Promoted