Career Opportunities with Capital Rx

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Formulary Operations Specialist

Department: Clinical Operations
Location: New York, NY

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

Position Responsibilities:

  • Support the weekly, monthly, and quarterly maintenance and quality assurance checks of standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace
  • Assist the Pharmacists in operationalizing and implementing custom client and standard formulary and benefit requests within the formulary management and adjudication platform
  • Cross functional support for claim troubleshooting through the adjudication platform
  • Review formulary testing output templates for formulary accuracy
  • Support the creation and validation of client and member formulary marketing materials
  • Completes assigned work plan objectives and projects on a timely basis
  • Ensure quality assurance and formulary accuracy
  • Support quality improvement projects, as required
  • Support RFI and RFP submissions, as required
  • Support general business needs and operations, as required
  • Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Minimum Qualifications:

  • Registered Pharmacy Technician license
  • Certification from the national Pharmacy Technician Certification Board or National Health career Association or equivalent experience
  • 3+ years of pharmacy experience working for a health plan or PBM
  • Proficient in Microsoft office suite with emphasis on Microsoft excel including advanced Microsoft Excel functions, VBA, macros, etc.
  • Experience working with large datasets required
  • Knowledge of pharmacy claims processing drug names, and pharmacy/medical terminology
  • High attention to detail required
  • Ability to work independently and accurately in a fast-paced environment
  • Flexible, highly organized, and able to shift priorities easily
  • Ability to balance multiple projects simultaneously
  • Commitment to delivering high quality work product

Preferred Qualifications:

  • Formulary development and maintenance process experience at a PBM or health plan including experience with custom client benefit and formulary design highly preferred

Base Salary: $50,000 - $65,000

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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