Department

Job Title

Capital Rx is redefining the way prescriptions are priced and administered in the U.S. Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes. The company's commitment to innovation, technology, and service is why Capital Rx is the fastest-growing pharmacy benefit manager in America.

Clinical Operations

Supervisor, Clinical Care Quality Assurance

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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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

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• The Supervisor, Quality Assurance, Clinical Care reports to the Manager, Clinical Care and is responsible for internal quality management
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• Ensure the Clinical Care Team complies with policy, practices and procedures set forth by Capital Rx
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• Monitor calls, review findings and assist with development and compliance with improvement plans set forth by the Clinical Care Manager and Supervisors on a regular basis and as requested
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• Monitor overrides to assure appropriateness and accuracy
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• Track weekly prior authorization metrics
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• Track call center data and build and maintain reporting
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• Provide and maintain detailed and thorough documentation for all required/requested reporting
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• Identify training opportunities for individuals, the team, and department performance improvement and support staff training as needed
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• Monitor and track service-related concerns/complaints and follow up as needed within required time frames
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• Track and maintain reporting for annual training, licensure and annual goals for each Clinical Care team member
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• Ensure customer satisfaction, demonstrate genuine compassion and care, optimize the customer experience and provide professional customer support and service
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• Effectively ask probing questions to identify and resolve issues and address concerns effectively, efficiently and in a timely manner
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• Effectively communicate issues and resolutions to members, pharmacies, providers and appropriate internal stakeholders
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• Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities
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• Follow all internal Standard Operating Procedures, job aids, Policies and Procedures, and adhere to HIPAA guidelines and policies
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• 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
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• Support the Fraud, Waste and Abuse program by communicating any findings to appropriate internal staff
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• Deliver extraordinary customer care and service by responding to questions concerning customer accounts in a fast paced, structured environment within established time frame
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• Support staff training and development as required
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• 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
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• Maintain compliance with federal, state, local, and organizational laws, regulations, guidelines, and policies
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Required Qualifications:

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• Active, unrestricted pharmacist license
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• Bachelor’s or Doctor of Pharmacy Degree with 2+ years of pharmacy practice experience
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• Minimum of one year experience in customer service and call center in a PBM setting, auditing experience preferred
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• Excellent communication (oral and written) and organizational skills
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• Advanced Microsoft Excel experience
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• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
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• Self-motivated and detail-oriented problem solver
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• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
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• 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
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• Internet speed of one gigabyte (940bps) is required
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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.

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.