Clinical Programs Pharmacist

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 subject matter expert, providing comprehensive support for the operations of clinical programs and associated initiatives. This includes, but is not limited to, prioritizing incoming calls, conducting outreach, effectively communicating issues and resolutions to stakeholders, and adhering to internal Standard Operating Procedures, job aids, Policies and Procedures, as well as complying with HIPAA guidelines and policies. 

Position Responsibilities: 

• Triage clinical incoming calls and conduct clinical outreach calls to members, pharmacies, and prescribers 
• Support operations of clinical programs, including pharmacogenomics, MTM (Medication Therapy Management), lower cost alternative, retrospective drug utilization reviews, and other clinical initiatives as needed 
• Provide on call support as needed for after-hours pharmacist/clinical programs/emergent calls on rotating schedule that includes nights, weekends, and holidays 
• Ensure customer satisfaction, demonstrate genuine compassion and care, optimize the customer experience, and provide professional customer support and service 
• Meet or exceed performance metrics while maintaining quality and providing superior customer service to all stakeholders 
• Effectively ask probing questions to identify and resolve multiple issues and address concerns effectively, efficiently, and in a timely manner 
• Communicate issues and resolutions to members, pharmacies, providers, and appropriate internal stakeholders 
• Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities 
• Follow all internal Standard Operating Procedures, job aids, Policies and Procedures, and adhere to HIPAA guidelines and policies 
• Follow all procedures to protect patients through safeguards for data integrity, confidentiality, and security of information as required by policies and procedures and accreditation entities 
• Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information and communicating findings to appropriate internal staff 
• Deliver extraordinary customer care and service by responding to questions concerning customer accounts in a fast paced, structured environment within established time frame 
• Support Manager/Supervisor by assisting with additional projects as requested 
• Support staff training and development as required 
• Work collaboratively with internal business and clinical partners to support initiatives including clinical interventions, data and claims review, and on-boarding of new clients, as required 
• Maintain compliance with federal, state, local, and organizational laws, regulations, guidelines, and policies 
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. 

Minimum Qualifications: 

• Active, unrestricted pharmacist license 
• Bachelor's or Doctor of Pharmacy Degree with 2+ years of clinical pharmacy practice experience 
• Experience in customer service or call center experience required 
• 2+ years of prior managed care and/or clinical program administration experience and/or completion of a PGY1 Pharmacy Residency Program required 
• Excellent communication (oral and written) and organizational skills 
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment 
• Self-motivated and detail-oriented problem solver 
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team 
• Have a designated workspace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations 
• Have the following internet connectivity: DSL, cable modem or fiber with a wired connection to device (wi-fi not allowed). Internet speed of one gigabyte (940bps) is required 

Preferred Qualifications: 

• Pharmacogenomics (PGx) certification highly preferred 
• Medication Therapy Management (MTM) experience preferred 

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.