Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

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.

Job Summary:

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.

Qualifications:

Education

• Bachelor's Degree required and Master's Degree preferred

Licenses and Credentials

• Active and good-standing Pharmacist license required

Experience

• At least 5-7 years of experience in clinical informatics required

Knowledge, Skills, and Abilities

• 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.

Additional Job Details (if applicable)

Working Conditions

• This is a full-time remote position that can be done from most US states

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours:

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$117,707.20 - $171,204.80/Annual

Grade

8

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.