Location: Remote (For Non-Local) or Hybrid (Local to NYC area)
Position Summary:
Capital Rx is seeking a self-driven pharmacist with operating and leadership experience in medical pharmacy utilization management review across all lines of business (Medicare, Medicaid, Exchange, Commercial). This client facing role will report to the Manager, Customer Success and be accountable for onboarding and servicing new and existing clients of JUDI�s Prior Authorization Tool. This person will be expected maintain an in-depth understanding of the evolving capabilities of JUDI�s Prior Authorization Tool. Exceptional communication skills and attention to detail are critical for communicating with clients in a manner that facilitates their ability to successfully adopt the tool into their own utilization management workflow.
Position Responsibilities:
- Build and maintain trusting relationships with clients through superior customer service. Provide oversight of the clients ongoing use of JUDI�s Prior Authorization Tool.
- Accountable for accurate and timely transition of new clients to JUDI�s Prior Authorization Tool.
- Lead communications throughout the implementation process, including, but not limited to, detailed and strategic guidance through criteria, letter, and turnaround time configuration, as well as queue management and reporting expectations.
- Proactively identify execution risks and mitigation strategies.
- Provide ongoing client support to troubleshooting inquiries.
- Understand and manage requests for new features in alignment with the product roadmap.
- Support configuration of delegated services into the prior authorization tool, audits, and third-party integrations.
- Partner with product managers and directors operating in an agile framework to conceptualize and break down functional and non-functional requirements needed to be the market leading offering for prior authorization processing.
- Provide clinical, regulatory, and accreditation standard (URAC, NCQA) subject matter expertise to ensure the tool�s adoption is compliant with all mandated regulations and efficiently supports audit requirements.
- Identify and drive efficiencies to increase rate of adoption in market.
- Provide virtual and in person product demonstrations to prospective clients with the ability to sell product differentiators and resonate with current operational challenges.
- Certain times of year may require meeting participation, service support or other requirements outside of standard business hours, including weekends.
- Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.
Minimum Qualifications:
- Active, unrestricted, pharmacist license
- Bachelors or Doctor of Pharmacy (PharmD) Degree
- 3+ years of pharmacy practice experience in a PBM or Health Plan
- 1+ year of medical pharmacy experience
- Subject matter expertise in coverage determination and appeals reviews and audits across all lines of business
- Experience operating multiple prior authorization software solutions
- Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
- Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction
- Ability to shift between competing priorities and meet organizational goals
- Proficient in Microsoft office Suite and willing to adapt to software such as Jira, Lucid, Confluence, Github, and AWS Redshift.
- Excellent verbal, written, interpersonal and presentation skills
- Ability to work effectively with virtual teams
Base Salary: $120,000 - $130,000
Nothing in this position description restricts management�s right to assign or reassign duties and responsibilities to this job at any time.
About Capital Rx
Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation�s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp�, Capital Rx is executing its mission through the deployment of JUDI�, the company�s cloud-native enterprise health platform, and a Single-Ledger Model�, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy 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 pharmacy benefits and rebuilding trust in healthcare.
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.
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