Senior Clinical Account Manager

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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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:

• Provide oversight of client account management team with a focus on member and client satisfaction, trend management, client retention, and regulatory compliance
• Partner with account team members and internal support teams to provide best-in-class member and client service
• Identify resolution efforts of client and member issues as it impacts multiple clients across market segment
• Lead development of client relationship strategy plans
• Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for clinical and plan management strategies
• Analyze and interpret pharmacy claims data to identify clinical and plan trends and insights for individual clients and across multiple clients
• Interpret current pharmacy and healthcare trends and provide proactive recommendations for plan management
• Incorporate treatment & practice guidelines, clinical education, and pharmacy pipeline details into client presentations
• Comprehend and effectively explain formulary and clinical programs to clients, including member experience, book of business experience, regulatory requirements
• Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries
• Support 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 output
• Analyze and evaluate pharmacy benefit reporting and create ad-hoc reports as requested
• Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations
• Lead key internal operations initiatives and general business needs/operations, as required
• Provide guidance on internal and external collaborative projects and needs
• Identify and contribute to process improvement efforts
• Coach and mentor junior team members
• Certain 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 performance
• 5+ years relevant experience in pharmacy - health plan, health insurance marketplace (HIM), managed care, or pharmacy benefits management (PBM) experience preferred; or completion of managed care residency
• 3+ years of prior account management experience
• Prior experience in Medicare or Medicaid desired
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel
• Experience working with large datasets and analyzing raw data in Excel
• Ability to balance multiple complex projects simultaneously
• Exceptional written and verbal communication skills
• Flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Ability to travel and present to small and large groups

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.