Regional Business Director – Nephrology/Rare Disease
EVERSANA
Director, Pharmacy Analytics
SmartLight Analytics
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Lead the pharmacy-related functions within SmartLight Analytics
- Focus on ensuring the accuracy, efficiency, and compliance of pharmacy claims processing
- Identify and prevent fraud, waste, and abuse (FWA) using advanced analytics
- Collaborate with cross-functional teams to develop and implement pharmacy strategies
- Oversee the design, development, and execution of pharmacy programs to support payer and provider partnerships
Requirements
- PharmD, with a Managed Care Residency preferred
- 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.
Benefits
- Professional development
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
pharmacy claims processingfraud detectionpayment integrity processespharmacy reimbursement modelspharmacy compliancedata analyticsbusiness intelligence toolspharmacy claims auditing
Soft skills
leadershipcollaborationstrategic development
Certifications
PharmDManaged Care Residency
