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

About Capital Rx

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology and service is the reason why Capital Rx is among the fastest growing PBMs in the country.

Position Responsibilities:

• Triage, investigate and resolve escalated clinical phone calls and cases from members, pharmacies, and prescribers
• Provide support for clinical programs as needed, including triaging incoming clinical calls, and conducting outreach calls to members, pharmacies, and prescribers
• Provide on call support as needed for after-hours pharmacist/clinical programs/emergent calls on rotating schedule that includes nights, weekends, and holidays
• Provide detailed and thorough documentation in prior authorization cases, overrides and call center cases
• Support Prior Authorization Team during peak volume times or as needed
• Perform peer-to-peer reviews with providers when requested
• 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
• Effectively 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 questionsconcerning 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
• Maintain compliance with federal, state, local, and organizational laws, regulations, guidelines, and policies

Required Qualifications:

• Active, unrestricted pharmacist license
• Bachelor's or Doctor of Pharmacy degree with 2 years of pharmacy practice experience
• Experience in customer service, call center, and prior authorization preferred
• Excellent communication, writing, 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

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

This range represents the low and high end of the anticipated base salary range for the NY-based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

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.