What you’ll do

In a few words…                                                

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

As the Drug Value Strategy Senior Manager, you will be using your coding skills to manage and transform big data into meaningful information and customized solutions for our clients. For this critical role, the best person would be a current coding professional (Python, R, SQL, etc.)  that loves to develop creative solutions and visualizations to effectively and efficiently solve problems and communicate analysis. 

The person in this critical role will be focused on developing the best tools to provide advanced data reporting for our clients.  One area of responsibility for this role is specialty report development.  This includes reporting for the specialty pharmacy network’s current cost saving initiatives and auditing of specialty claims.  This role would also be communicating with the specialty network and other key external stakeholders on a regular basis to ensure accurate and consistent reporting. This critical role will be part of the team that is developing outside the box solutions that provide actionable data insights to our clients.   This is an ideal role for someone looking for an opportunity to make a big impact, and have an opportunity to develop innovative tools, while having the flexibility and autonomy of a remote work environment.                    

The fundamentals for the job…

• Design and develop data solutions - utilize data mining, data modeling, natural language processing, and machine learning to extract insights from large data sources.
• Evaluate data scenarios through a product-oriented lens and deliver predictive models that inform business solutions as part of the drug value strategy portfolio.
• Utilize data-oriented programming languages and visualization software to explore, analyze, and interpret large volumes of data in various forms and solve complex business problems.
• Lead the development of analytic tools that will provide data reporting for our clients.
• Develop and manage new and innovative specialty programs based on collaboration with the specialty network of pharmacies and track progress (partnerships (i.e. ROI, launch of initiatives, outreach, metric tracking, etc.)
• Develop monthly and quarterly specialty spend reports to include initiatives, trends in the market, pipeline drugs, and other impactful events
• Optimize and manage specialty claims auditing process (in conjunction with analytics team)
• Drive generation of client-facing tools that help with feasibility, context, and budget and drug forecast models
• Serve as a SME to the analytics team to develop complex reporting.
• Other tasks and projects as needed

What we expect of you

The bold requirements… 

• Bachelor’s degree in business or related area of study, or equivalent combination of education and/or related work experience (In lieu of a degree, equivalent relevant experience may be considered.)
• 8+ years of experience with working with healthcare data analytics (e.g. medical and pharmacy claims data)
• 2+ years of experience with medical or pharmacy data in a health plan or pharmacy benefit manager (PBM).
• Excellent written, interpersonal communication, and presentation skills, including ability to present complex technical concepts in a clear, concise manner to audiences with varying levels of technical understanding
• Experience in Python, R, SQL, advanced statistical methods, and advanced proficiency to utilize data-oriented programming languages, statistical modeling, and visualization software (such as Tableau, PowerBI, etc.)
• Experience with cloud-based data analysis (such as Snowflake)
• Strong problem-solving skills in healthcare cost and utilization analysis
• Experience in project management, KPI’s, and data visualization.
• Experience managing key strategic initiatives in healthcare/PBM industry.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to have…

• Multiple successfully completed data science projects involving ML or algorithm application. For example, prediction of clinical outcomes (disease state complications using support vector machines).
• Expertise in healthcare coding (CPT, ICD, HCPCS).
• Understanding of the healthcare market dynamics.
• Significant experience in formulary and regulatory requirements for Medicaid and/or Medicare
• Experience in designing and developing AI applications and systems.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

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