Medical Informatics Analyst, Consultant - Pharmacy Strategy and Operations

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

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 Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations at Blue Shield of California (BSC). The Rx Analytics and Reporting team drives analytics strategy and performs clinical and business analyses to provide consultations and strategic program recommendations. The Medical Informatics Analyst, Consultant, Clinical Programs Analytics will report to the Manager, Medical Informatics. In this role you will support either Clinical Programs Analytics, Operational Analytics, or Cost of Health Care Analytics.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work 
In this role, you will:

• Conduct independent analysis of high complexity under minimal supervision and guidance 
• Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
• Produce analysis of high complexity under the guidance and direction of Medical Informatics Analyst Principal, supervisor or manager
• Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team
• Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conduct formal training sessions for lower-level analysts and analysts in other Departments 
• Support Clinical Pharmacy Program Analytics & Reporting, including adherence and other reporting to support HEDIS and Medicare Stars initiatives
• Lead Accountable Care Organization and Provider Pharmacy Analytics & Reporting
• Support Pharmacy Medicare and Medi-Cal Analytics and Reporting
• Support Pharmacy Operational analyses and reporting, as needed
• Support Pharmacy Cost of Health Care analyses and reporting, as needed
• Support Operation Analytics, including member mailings, Prior Authorization, Benefits & Claims
• Support Pharmacy Infomart implementation and Netezza Sandbox retirement 
• Drive team strategy around self-service reporting tools (e.g., Tableau, SAS Viya, etc.)
• Track cost and utilization of specialty drugs on Rx and Medical benefit for LOB and Employer Group reporting
• Support monitoring of Financial Contract Performance with Stellarus teams (e.g., Service Provider Network Performance, Evio)
• Lead evaluation of COHC savings for pharmacy initiatives
• Provide pharmacy utilization and cost reports to evaluate trend drivers
• Track cost and utilization of specialty drugs on Pharmacy and Medical benefit for Line of Business and Employer Group reporting
• Support Clinical Pharmacy Program Analytics, as needed

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 7 years of prior relevant experience, and 5 years of experience as a Health Data Analyst, Medical Economist, or in a related role within a healthcare setting. Additionally, 5 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims data sets is required
• Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred
• Data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS Viya, Snowflake SQL, Tableau)
• Ability to leverage business and data knowledge to interpret health plan benefit utilization
• Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.