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Director of Network and Pricing Configuration

Department: Enterprise Solutions
Location: New York, NY

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

Position Background

Capital Rx is seeking a self-driven leader with operating experience in pharmacy network and pricing configuration across all lines of business (Medicare, Medicaid, Exchange, Commercial). This customer facing role will be accountable for implementation and ongoing support for Software as a Service (SaaS) users of JUDI. This person will be expected maintain an in-depth understanding of the evolving capabilities of JUDI and contribute to the development needs to surface new configuration needs to support SaaS customers migrations. This person must be flexible and willing to expand their support and knowledge outside of their core functions in JUDI. Exceptional communication, service skills and attention to detail are critical for communicating with customers in a manner that facilitates their ability to successfully utilize JUDI for support of their own pharmacy administration operations.

Position Responsibilities

  • Lead communications throughout the network and pricing workstream implementation process, including, but not limited to, detailed and strategic guidance through efficient use JUDIs network and pricing services, as well as network reporting expectations.
  • Leads team of individuals responsible for providing configuration services and support oversight of SaaS customers use of JUDIís Network, Pricing and Benefits modules.
  • Ensure comprehensive testing is conducted and reviewed of customers network requirements, client pricing using JUDIs Testing Module.
  • Hold team members accountable for providing ongoing customer support to troubleshooting inquiries within required turnaround times to meet service level guarantees.
  • Ensure performance guarantees are met regarding claim processing accuracy.
  • Build and maintain trusting relationships with SaaS customers through superior service.
  • Accountable for accurate and timely transition of new SaaS customers to JUDI.
  • Identify and drive efficiencies to increase rate changes to pricing and network configurations for SaaS customers processes.
  • Develops pharmacy network and pricing reports to meet customerís needs.
  • Create and maintain documentation to support network and pricing configuration processes.
  • Provide user training to SaaS customers as needed.
  • Proactively identify execution risks and mitigation strategies.
  • Understand and manage requests for new features in alignment with existing and planned system capabilities.
  • Support testing for new JUDI functionality and regression testing to ensure new enhancements are functioning as expected and accurately processing claims transactions.
  • Provide virtual and in person product demonstrations, with the ability to sell product differentiators and resonate with current operational challenges.
  • Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends.

Required Qualifications

  • Bachelorís Degree in relevant field or 10+ yearís experience in PBM or Health Plan setting required
  • 5+ years of pharmacy network and pricing experience in a PBM or Health Plan
  • 5+ years in a leadership role
  • 1-2 years of SQL experience and managing large data sets.
  • PBM and/or pharmacy technician experience preferred.
  • Medicare Part D subject matter expertise in plan finder pharmacy files, pharmacy directories and other pharmacy related reporting.
  • Experience operating multiple claims adjudication systems.
  • Understanding of openAPI architecture to support both customersí business process transformation
  • Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
  • Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction.
  • Ability to shift between competing priorities and meet organizational goals.
  • Proficient in Microsoft office Suite and willing to adapt to software such as Jira, Miro, Confluence, Github, and AWS Redshift.
  • Excellent verbal, written, interpersonal and presentation skills.
  • Ability to work effectively with virtual teams.
  • Ability to travel 5-10%

Nothing in this position description restricts managementís 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 nationís electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corpô, Capital Rx is executing its mission through the deployment of JUDIģ, the companyís cloud-native enterprise health platform, and a Single-Ledger Modelô, 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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