Clinical Programs Specialist

Job Description:

About Capital Rx

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

Acts as a dedicated specialist responsible for leading administrative and operational tasks to facilitate the execution of clinical programs and clinical initiatives, including but not limited to, triaging incoming calls, conducting outreach, managing and maintaining drug lists, and supporting reporting requirements.

Position Responsibilities:

• Work with the Clinical Programs team to triage incoming clinical programs calls, schedule appointments for consultations and conduct outreaches to prescribers, pharmacies, and members 
• Lead administrative and operational tasks to support the implementation of clinical programs, including but not limited to Capital Rx’s pharmacogenomics, MTM (Medication Therapy Management), lower cost alternative solutions, opioid safety edits, cost containment, and other clinical initiatives as needed
• Manage and maintain drug lists to support operations of clinical programs including periodic drug list maintenance, weekly and quarterly list reviews, and ad-hoc updates
• Support reporting requirements, monitor claims, and ensure communication amongst all stakeholders including internal and external partners
• Identify, document, and effectively communicate issues to appropriate internal stakeholders ensuring customers receive quality care and resolution meets all health and safety standards
• Work collaboratively with internal business and clinical partners to support clinical program initiatives as required
• Ensure customer satisfaction, demonstrate genuine compassion and care, and provide professional customer service in a fast paced, startup environment
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
• Uphold general business needs and operations as required
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Minimum Qualifications:

• Active, unrestricted pharmacy technician license
• 2+ years of applicable experience in a clinical pharmacy setting PBM, health plan, or related health care experience
• 1+ year of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication
• Ability to balance multiple complex projects simultaneously with minimal direction

Preferred Qualifications:

• Medication Therapy Management (MTM) experience preferred
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Experience with Confluence, Jira, Tableau, Salesforce
• Highly detail-oriented and analytical
• Bilingual- Spanish preferred

Salary Range

$55,000 - $65,000 USD

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. 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.