Clinical Pharmacy Informatics Lead

Mass General Brigham•Somerville, MA

3d•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The Clinical Pharmacy Informatics Lead is responsible for the day-to-day management, configuration, and optimization of clinical pharmacy systems and data that support the health plan’s pharmacy benefit across all lines of business. This role operates at the intersection of Clinical Pharmacy, Pharmacy Operations, IT, Finance, Compliance, Quality, and Enterprise Analytics to ensure systems accurately translate clinical intent into operational workflows, claims adjudication, and analytics that drive business objectives. This position leads the implementation and ongoing maintenance of clinical pharmacy operations, including formulary and utilization management builds, clinical edits, benefit structures, and drug coverage logic within core platforms. The Clinical Pharmacy Informatics Lead performs oversight of vendors (via testing and ROI evaluation support, validates system performance, troubleshoots issues, and ensures alignment between benefit design, utilization management policy, and adjudication outcomes. The role is accountable for data integrity and serves as a primary resource for identifying claims, authorization, and eligibility discrepancies that may impact member experience, provider abrasion, or reporting accuracy. A core responsibility of this role is generating actionable insights for leadership. The Lead collaborates with internal partners to identify, extract, and analyze pharmacy-related data. Working closely with analytics, quality, finance, and compliance teams, the Lead defines business requirements, interprets clinical and operational needs, validates data outputs, and communicates findings. The Clinical Pharmacy Informatics Lead plays a critical role in audit readiness by ensuring system logic, configuration documentation, testing evidence, and data traceability support CMS, state, and accreditation requirements. The role partners in audit preparation, supports universes and record validation, and assists with remediation and corrective action activities. This position also supports Stars, HEDIS, and other quality initiatives by enabling accurate identification of target populations, validating measure logic, and ensuring pharmacy data feeds and reports are complete, timely, and defensible. Additionally, the lead contributes to financial and utilization trend reporting, supporting rebate operations, budget forecasting, drug spend analysis, and identification of cost-of-care opportunities. The Clinical Pharmacy Informatics Lead identifies opportunities for automation and process improvement, contributes to SOP development, and provides subject matter expertise for system enhancements, upgrades, and vendor implementations. Success in this role requires strong technical aptitude, deep understanding of the pharmacy benefit, and the ability to convert complex cross-functional requirements into practical system and data solutions.

Requirements

Bachelor's Degree required
Active and good-standing Pharmacist license required
At least 5-7 years of experience in clinical informatics required
Authority-level knowledge of clinical operations and related business processes.
Excellent leadership and supervisory skills.
Excellent problem-solving and organizational skills.
Proficient with standard office technologies and software.
Strategic and able to quickly understand and discuss situations and challenges.

Nice To Haves

Master's Degree preferred

Responsibilities

Responsible for the day-to-day management, configuration, and optimization of clinical pharmacy systems and data that support the health plan’s pharmacy benefit across all lines of business.
Leads the implementation and ongoing maintenance of clinical pharmacy operations, including formulary and utilization management builds, clinical edits, benefit structures, and drug coverage logic within core platforms.
Performs oversight of vendors (via testing and ROI evaluation support, validates system performance, troubleshoots issues, and ensures alignment between benefit design, utilization management policy, and adjudication outcomes.
Accountable for data integrity and serves as a primary resource for identifying claims, authorization, and eligibility discrepancies that may impact member experience, provider abrasion, or reporting accuracy.
Generating actionable insights for leadership.
Collaborates with internal partners to identify, extract, and analyze pharmacy-related data.
Plays a critical role in audit readiness by ensuring system logic, configuration documentation, testing evidence, and data traceability support CMS, state, and accreditation requirements.
Supports Stars, HEDIS, and other quality initiatives by enabling accurate identification of target populations, validating measure logic, and ensuring pharmacy data feeds and reports are complete, timely, and defensible.
Contributes to financial and utilization trend reporting, supporting rebate operations, budget forecasting, drug spend analysis, and identification of cost-of-care opportunities.
Identifies opportunities for automation and process improvement, contributes to SOP development, and provides subject matter expertise for system enhancements, upgrades, and vendor implementations.