Career Opportunities with Capital Rx

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Manager, Clinical Care

Department: Clinical Operations

Location: Remote

Position Responsibilities:

  • Lead and support a dynamic team of clinical pharmacists dedicated to clinical care across all lines of business (Commercial, Exchange, Medicaid and Medicare)
  • Ensure clinical, regulatory and accreditation standards are met and in compliance
  • Establish departmental goals and deadlines in compliance and alignment with Capital Rx’s plans and vision
  • Support and collaborate with the Chief Clinical Officer, stakeholders, other departments and team members on additional tasks, projects, and commitments as required
  • Collaborate cross-functionally with internal business and clinical partners to support initiatives including clinical interventions, clinical programs, data and claims review, as well as identify and drive actions to improve efficiency and provide recommendations for process improvement
  • Support implementation and onboarding of new clients as needed, including client facing meetings and correspondence
  • Manage, schedule and create agenda for monthly stakeholder meetings between PA, Formulary, Customer Care and Clinical Care
  • Create and maximize clinical efficiency by managing team schedules and assessing data for optimal staffing, continuously critically evaluating staffing levels, balancing call center and Clinical Programs needs and reviewing call types/topics
  • Lead the recruitment process for new hires, support staff training and development, including identifying career opportunities, coach and provide guidance to supervisors and Clinical Care pharmacists
  • Manage and execute day-to-day clinical care pharmacist functions as needed to support the Clinical Care team during peak volume
  • Regularly evaluate and assess performance of the clinical care team, providing consistent feedback, including performance reviews
  • Request, generate and report or present scheduled or ad-hoc comprehensive reports on clinical care metrics/data to internal or external stakeholders
  • Ensure customer satisfaction, demonstrate genuine compassion and care, optimize the customer experience, and provide professional customer support and service
  • Remain current on all communications and updated processes relayed through multiple communication channels and ensure team is up-to date
  • Follow all internal Standard Operating Procedures, job aids, Policies and Procedures, and adhere to HIPAA guidelines and policies
  • Maintain compliance with federal, state, local, and organizational laws, regulations, guidelines, and policies
  • Provide on call support as needed for after-hours pharmacist/clinical programs/emergent calls on rotating schedule that includes nights, weekends, and holidays
  • Deliver extraordinary customer care and service by responding to all questions concerning customer accounts in a fast paced, structured environment within established time frame
  • Certain times of year may require meeting participation, team support or other requirements outside of standard business hours, including evenings, weekends and holidays
  • Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance
  • 2+ years of PBM experience required
  • Experience in customer service, call center, or prior authorization required
  • Exhibit strong written communication and oral presentation skills

Minimum Qualifications:

  • Active, unrestricted pharmacist license
  • Bachelor's or Doctor of Pharmacy Degree with 2+ years of pharmacy practice experience
  • Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
  • Self-motivated, critical thinker and detail-oriented problem solver
  • Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
  • Proficient in Microsoft Office with an emphasis on PowerPoint and Excel
  • Workspace requirements: 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
  • Internet connectivity requirements: 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:

  • 3+ years of leadership experience preferred

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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