Director, Network Informatics & Analytics

This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/13821962\ \ Overview\ Do you have strong experience in data modeling and analytics at a PBM or healthcare company? Due to continued growth, this add to headcount role will drive value as we are expanding our team to include a Director, Network Informatics & Analytics. Please note, this isnot an IT Network position. The Director, Network Informatics & Analytics is a strategic leadership role responsible for the data, informatics, analytics, and quality governance that support pharmacy network contracting across Chain, Specialty, and Independent/Affiliated networks. This role serves as the centralized owner of network and contract data integrity, analytics, reporting, and analytical validation of outcomes. This leader ensures that contract terms negotiated by Network Contracting are accurately represented in data and continuously assessed through analytics to provide insight into claims outcomes and network performance. In addition, this role will drive the development of advanced network models and analytical frameworks to evaluate reimbursement strategies, provider performance, and overall network cost effectiveness, enabling data-driven decision-making across the organization. The Director functions as a key strategic partner to Network Contracting leadership, providing actionable insights, predictive analytics, and proactive identification of risks and opportunities to optimize network performance and inform strategic decisions. Is this you? Find out more below! \ \ Responsibilities\ How do I make an impact on my team? Data Governance & Informatics Leadership - Own and evolve the informatics framework supporting pharmacy network contracting, including contract attributes, reimbursement methodologies, network hierarchies, and provider identifiers - Establish and maintain data standards, definitions, and governance controls to ensure data consistency, usability, and integrity across systems and reporting environments - Serve as the centralized authority for network and contract data quality, enabling reliable and scalable analytics Advanced Analytics & Network Modeling - Design and develop network models to evaluate reimbursement structures, pricing strategies, and financial impact across pharmacy segments - Build analytical frameworks to assess provider cost, performance, and value (e.g., scorecards, cost-of-care, network efficiency) - Identify optimization opportunities through scenario modeling, trend analysis, and performance insights - Partner with Finance, Actuarial, and Strategy teams to support forecasting, pricing decisions, and client-facing analytics Reporting & Insights - Lead development and maintenance of standardized reporting and dashboards for network performance, reimbursement trends, and contract alignment - Deliver actionable insights through routine and ad hoc analyses, including trend identification, outlier detection, and emerging risk monitoring - Establish KPI frameworks to measure network effectiveness, cost efficiency, and overall performance across pharmacy segments Quality Oversight & Analytical Validation Establish and oversee analytical quality control frameworks to assess alignment between contract intent and observed claims and network performance outcomes Develop monitoring approaches that surface discrepancies, emerging risks, or unintended financia\ \ \ \ Equal employment opportunity, including veterans and individuals with disabilities.\ \ PI287944736