Remote

Clinical Care Pharmacist

Capital Rx
United States, New York, New York
Oct 03, 2024
Clinical Care Pharmacist Location: Remote (For Non-Local) or Hybrid (Local to NYC area) 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 Support Prior Authorization Team during peak volume times or as needed Perform peer-to-peer reviews with providers when requested Provide detailed and thorough documentation in prior authorization cases, overrides and call center cases 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 questions concerning customer accounts in a fast paced, structured environment within established time frame 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 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 Available to work a shift from 11:30am-8pm EST and weekend availability Base Salary: $120,000 - $125,000 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. #LI-SE1 Apply For This Position