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Clinical Account Manager - Health Plans

Department: Clinical Account Management
Location: New York, NY

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

Position Responsibilities:

  • Provide oversight of client account management team with a focus on member and client satisfaction, trend management, client retention, and regulatory compliance
  • Partner with account team members and internal support teams to provide best-in-class member and client service
  • Identify resolution efforts of client and member issues as it impacts multiple clients across market segment
  • Lead development of client relationship strategy plans
  • Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for clinical and plan management strategies
  • Analyze and interpret pharmacy claims data to identify clinical and plan trends and insights for individual clients and across multiple clients
  • Interpret current pharmacy and healthcare trends and provide proactive recommendations for plan management
  • Incorporate treatment & practice guidelines, clinical education, and pharmacy pipeline details into client presentations
  • Comprehend and effectively explain formulary and clinical programs to clients, including member experience, book of business experience, regulatory requirements
  • Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries
  • Support implementation of new clients, plans, plan changes, and other plan set-up requirements. This may include: gathering plan requirements, building/coding plans, conducting peer-review quality control, review of testing and claims output
  • Analyze and evaluate pharmacy benefit reporting and create ad-hoc reports as requested
  • Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations
  • Lead key internal operations initiatives and general business needs/operations, as required
  • Provide guidance on internal and external collaborative projects and needs
  • Identify and contribute to process improvement efforts
  • Coach and mentor junior team members
  • Certain times of year may require meeting participation, testing, claims review, or other requirements outside of standard business hours, including weekends

Required Qualifications:

  • Bachelor of Pharmacy (B.S. Pharmacy) or Doctor of Pharmacy (PharmD) degree from an accredited institution, with record of strong academic performance
  • Relevant experience for at least five (5) years in pharmacy - health plan, health insurance marketplace (HIM), managed care, or pharmacy benefits management (PBM) experience preferred; or completion of managed care residency
  • Prior account management experience of at least three (3) years preferred
  • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel
  • Experience working with large datasets and analyzing raw data in Excel
  • Ability to balance multiple complex projects simultaneously
  • Exceptional written and verbal communication skills
  • Flexible, highly organized, and able to shift priorities easily
  • Attention to detail & commitment to delivering high quality work product
  • Ability to travel and present to small and large groups

Base Salary $130,000 - $150,000

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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