Capital Rx
Clinical Account Manager - PBA
Capital Rx, New York, New York, us, 10261
Clinical Account Manager - PBA
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 compliancePartner with account team members and internal support teams to provide best-in-class member and client serviceIdentify resolution efforts of client and member issues as it impacts multiple clients across market segmentLead development of client relationship strategy plansMeet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for clinical and plan management strategiesAnalyze and interpret pharmacy claims data to identify clinical and plan trends and insights for individual clients and across multiple clientsInterpret current pharmacy and healthcare trends and provide proactive recommendations for plan managementIncorporate treatment & practice guidelines, clinical education, and pharmacy pipeline details into client presentationsComprehend and effectively explain formulary and clinical programs to clients, including member experience, book of business experience, regulatory requirementsCommunicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiriesSupport 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 outputAnalyze and evaluate pharmacy benefit reporting and create ad-hoc reports as requestedCollaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentationsLead key internal operations initiatives and general business needs/operations, as requiredProvide guidance on internal and external collaborative projects and needsIdentify and contribute to process improvement effortsCoach and mentor junior team membersCertain 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 performanceRelevant 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 residencyPrior account management experience of at least three (3) years preferredProficient in Microsoft Office Suite with emphasis on Microsoft ExcelExperience working with large datasets and analyzing raw data in ExcelAbility to balance multiple complex projects simultaneouslyExceptional written and verbal communication skillsFlexible, highly organized, and able to shift priorities easilyAttention to detail & commitment to delivering high quality work productAbility to travel and present to small and large groups
Base Salary $130,000 - $150,000Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.About Capital RxCapital 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.#LI-PZ1Apply For This Position
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 compliancePartner with account team members and internal support teams to provide best-in-class member and client serviceIdentify resolution efforts of client and member issues as it impacts multiple clients across market segmentLead development of client relationship strategy plansMeet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for clinical and plan management strategiesAnalyze and interpret pharmacy claims data to identify clinical and plan trends and insights for individual clients and across multiple clientsInterpret current pharmacy and healthcare trends and provide proactive recommendations for plan managementIncorporate treatment & practice guidelines, clinical education, and pharmacy pipeline details into client presentationsComprehend and effectively explain formulary and clinical programs to clients, including member experience, book of business experience, regulatory requirementsCommunicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiriesSupport 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 outputAnalyze and evaluate pharmacy benefit reporting and create ad-hoc reports as requestedCollaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentationsLead key internal operations initiatives and general business needs/operations, as requiredProvide guidance on internal and external collaborative projects and needsIdentify and contribute to process improvement effortsCoach and mentor junior team membersCertain 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 performanceRelevant 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 residencyPrior account management experience of at least three (3) years preferredProficient in Microsoft Office Suite with emphasis on Microsoft ExcelExperience working with large datasets and analyzing raw data in ExcelAbility to balance multiple complex projects simultaneouslyExceptional written and verbal communication skillsFlexible, highly organized, and able to shift priorities easilyAttention to detail & commitment to delivering high quality work productAbility to travel and present to small and large groups
Base Salary $130,000 - $150,000Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.About Capital RxCapital 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.#LI-PZ1Apply For This Position