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 Analytics

Lead Cost Containment Clinical Analyst

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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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

High-performing individual contributor will be responsible for collaborating with other leaders across functional areas and drive analytic and process improvement initiatives in support of pharmaceutical cost containment. The right leader for this position has a clinical background and has a deep understanding of the PBM industry. They understand how formulary, network, and prior authorization requirements impact plan costs as well members. They are savvy to how changes in one area may create opportunity or collateral damage across functional areas. No expertise in data processing is required, as they will have full support of the analytics team to meet their data needs. They should however be able to document and give clear guidance as to their data needs and be able to provide thoughtful analysis and actionable recommendations based on their conclusions.

Position Responsibilities:

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• Work collaboratively across the analytics team to develop and maintain reports to monitor PMPM trends across core trend drivers.
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• Work cross-functionally with other departments to develop interventions and implement strategies addressing outliers or trends outside of industry benchmark and outlier claims.
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• Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
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• Continually monitor emerging market trends and vendors to stay atop latest capabilities in the market.
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• Monitor, report, and present effectiveness of interventions to show impact of recommendations made across functional areas including formulary and utilization management, clinical programs, and across all PMPM measures.
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• Implement quality control processes to ensure program compliance with established standards and guidelines.
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Required Qualifications:

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• RPh or Pharm D
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• 5+ years of applicable experience in a health plan or PBM and/or completion of a PGY1 Clinical Pharmacy Residency Program, Managed Care Residency or Fellowship with additional 1+ years of applicable experience
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• Maintain an active, unrestricted pharmacy license in the state of residence
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• Functional understanding of claims adjudication lifecycle and data handling.
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• Experience communicating business requirements to IT teams
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• Demonstrated experience creating, identifying, and leading initiatives that drive down pharmacy and or medical cost.
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• Expert knowledge of pharmacy cost trend drivers
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• Experience collaborating across teams
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• Ability to communicate findings and results clearly in written and in-person presentation.
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• Ability to balance multiple complex projects simultaneously.
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Preferred Qualifications:

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• Tableau developer
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• SQL
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• ROI Analysis
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• Project Management
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Base Salary: $115,000 - $160,000

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.

Additional Benefits Included: Annual Performance Based Bonus and Stock Options/Equity

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.