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

Position Responsibilities:

• Review, analyze and make recommendations to various reports including the Medicare Acumen Patient Safety reports, Medicare Acumen Operational reports, client produced reports, Capital Rx produced reports, etc.,
• Participate in Capital Rx’s opioid case management program including the Medicare Drug Management Program (DMP) and Overutilization Monitoring System (OMS) programs
• Create, implement, and manage quality initiatives (i.e. “deprescribing”) including the provision of monthly educational trainings.
• Actively participate in Clinical Value Committee (CVC).
• Work cross functionally to identify gaps and influence change/enhancements to business processes, policies, workflows, and system infrastructure to improve performance results, organization effectiveness based across the organization as it pertains to geriatric care.
• Provide oversight and monitor claims to ensure clinically appropriateness and make recommendations to clinical leadership to address issues with a focus on overutilization and polypharmacy, excessive use for antipsychotic medications, opioids, and other products impacting geriatric care.
• Participation in a once monthly targeted hospital case review with the clinical leadership team reviewing members who have been hospitalized recently for falls and are on specific drugs. Access to medical record / chart, labs, medication administration record, facility details, and other pertinent information to perform these activities.
• Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Minimum Qualifications:

• Doctor of Pharmacy (PharmD) Degree from an accredited institution
• Current, unrestricted registered pharmacist license(s)
• Board of Pharmacy Specialties (BPS) Geriatric Pharmacy Specialty Certification (BCGP), required
• Post-graduate experience in direct patient-care or managed care with members residing in long term care or institutional settings by providing appropriate medication reviews, consultation, and therapeutic recommendations on drug regimens
• Knowledge of highly managed specialty medications/strategy, formulary development and maintenance process, utilization management, clinical program/product development, P&T functions
• Proficient in Microsoft office Suite with emphasis on Microsoft Excel
• Ability to balance multiple complex projects simultaneously
• Exceptional written and verbal communication skills
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Ability to travel to support client needs, required
• Operational process improvement experience to include business problem identification, root cause analysis leveraging data and metrics, successful implementation of solutions with robust change management

Preferred Qualifications:

• Licensure in Colorado, Florida, Illinois, Massachusetts, Michigan, New Jersey, New York, or North Carolina, preferred
• Residency/fellowship preferred
• Pharmacy experience working for a health plan or PBM preferred
• Experience working with large datasets preferred

Base Salary: $135,000 - $165,000

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.