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Clinical Programs Business Development Manager
Location: Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)
Position Summary:
This individual will report to the Associate Director of Clinical Program Business Development and be responsible for supporting the sales and profitability of Capital Rx’s suite of clinical programs. This role serves as a primary business development lead for clinical offerings, from opportunity identification, client presentations, to negotiations and contracting. This role will drive clinical programs sales to new and existing PBM clients and foster strategic relationships with consultant groups. The ideal candidate will combine clinical expertise with strategic sales acumen to expand program adoption and deliver measurable value to clients.
Position Responsibilities:
Drive the sales strategy for Capital Rx’s suite of clinical programs end-to-end from prospecting through close in the small market and union sectors, including labor unions, municipal groups, and small employer-sponsored health plans.
Proactively assess client data to identify opportunities, meet with account teams to qualify opportunities, and deliver compelling presentations, proposals, and ROI analyses to prospects to drive clinical program sales.
Develop and implement strategic plans to identify, engage, and close new clinical program opportunities to achieve revenue targets.
Cultivate and manage trusted relationships with
Maintain a strong understanding of market dynamics, competitive landscape, and client needs to inform sales strategy.
Contribute to strategic client retention initiatives by aligning clinical programs with client goals.
Demonstrate strong analytical, presentation, and CRM skills to support sales execution and tracking.
Maintain a deep understanding of clinical programs, regulatory requirements (e.g., CMS, NCQA, URAC), and industry trends to effectively position our solutions.
Serve as a liaison between the field and internal product/clinical teams to ensure offerings remain competitive and relevant.
Support implementation handoffs to ensure smooth onboarding of new clients.
Provide market feedback to inform future product development and innovation.
Support general business needs and operations, as required.
All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.
Minimum Qualifications:
Education: Bachelor’s degree in Business, Healthcare Administration, or related field (MBA preferred)
7 years of total work experience. 5+ years of applicable experience in a health plan or PBM, or healthcare sales and/or completion of a PGY1 Clinical Pharmacy Residency Program, Managed Care Residency or Fellowship with additional 2+ years of applicable experience
Exceptional negotiation, presentation, and communication skills with the ability to articulate clinical value propositions to diverse audiences.
Experience engaging or partnering with pharmacy consultant firms
Working knowledge of pharmacy benefit management, Medicare Part D, and commercial pharmacy benefits
Ability to analyze data and market trends to inform sales strategy and client recommendations.
Proven track record of meeting or exceeding sales targets and successfully closing complex B2B deals.
Maintain an active, unrestricted pharmacy license in the state of residence
Ability to balance multiple complex projects simultaneously with minimal direction
Ability to travel up to 50%
Preferred Qualifications:
PharmD
Experience working with HEDIS, Stars and PQA pharmacy quality measures
Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
Experience with Confluence, Jira, Tableau
Highly detail-oriented and analytical
Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.
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.
Utilization Management Pharmacist (temp-to-hire)
Position Summary:
The Utilization Management Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service excellence in a fast-paced, collaborative environment.
Position Responsibilities:
Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach.
Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
Identify and report potential fraud, waste, and abuse.
Support training and development of new and existing team members as needed.
Assist leadership with special projects, process improvements, and operational initiatives
Minimum Qualifications:
Minimum of 6 months to a year of prior authorization or utilization management experience
Active, unrestricted, pharmacist license
Bachelor’s or Doctor of Pharmacy degree
Minimum of 2 years of pharmacy practice experience
Experience in managed care or pharmacy benefit management (PBM)
Strong communication, writing, and organizational skills
Ability to manage multiple priorities in a high-volume, metric-driven environment
Availability to work after hours, weekends, and holidays on a rotating schedule
Preferred Qualifications:
Call center experience
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.
Manager, Client Experience Resolution & Optimization (CERO)
Position Summary
The Manager of Client Experience Resolution & Optimization (CERO) leads the intake, triage, and resolution process for client-impacting issues within Client Services. This role establishes governance for intake workflows, ensures issues are accurately validated and routed, and drives consistency in how Client Services manages and resolves operational challenges. The Manager partners across the organization to streamline processes, reduce manual work, and improve end-to-end client experience, while providing coaching for the CERO Analyst.
Position Responsibilities:
Build and manage a standardized intake and routing process for Client Services issues.
Govern issue of triage, prioritization, and cross-functional coordination.
Serve as the primary point of contact for inquiries related to intake, validation, and routing.
Develop and maintain SOPs, workflows, and documentation supporting Client Services operations.
Establish and monitor high‑level performance indicators (e.g., intake volumes, turnaround times, quality measures) in partnership with internal analytics teams.
Lead continuous improvement initiatives aimed at simplifying workflows and reducing recurring issues.
Partner with functional teams to identify process gaps and support implementation of improvements.
Coach, mentor, and support ongoing development of the CERO Analyst.
Required Qualifications:
Bachelor’s degree is required
5+ years of experience in client services, operations, or workflow/process management.
Demonstrated success in establishing governance structures or managing intake of workflows.
Strong collaboration, communication, and organizational skills.
Ability to manage complexity and problem-solve in a fast-paced environment.
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