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
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance
• Maintain compliance with federal, state, local, and organizational laws, regulations, guidelines, and policies

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

Base Salary: $120,000-$125,000

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.