Clinical Formulary & Benefits Manager

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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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

  • Evaluate appropriateness and operationalize custom client formulary and benefit requests within Capital Rx’s adjudication platform
  • Manage and maintain clinical custom client elections
  • Test and maintain all clinical benefit requests to ensure client intent is met
  • Aid in the development of standard and custom batch testing scenarios and outputs, reviewing outputs to validate claim accuracy based on the client’s benefit and clinical elections
  • Make recommendations to streamline processes as it pertains to plan and benefit design
  • Communicate recommendation and testing process to clients in a concise manner
  • Support the formulary operations team in the maintenance of formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace
  • Analyze pharmacy cost of care, trends, and support the development of appropriate formulary programs and utilization management edits
  • Develop clinical criteria for review of non-formulary or non-preferred drug lists and communicate recommendations to clients
  • Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies
  • Support quality improvement projects, as required
  • Support general business needs and operations, as required

Qualifications / Profile:

  • Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance
  • Current, unrestricted registered pharmacist license(s)
  • Residency/fellowship preferred
  • 4+ years of pharmacy experience working for a health plan or PBM
  • Knowledge of client benefit design for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace
  • Knowledge of the formulary development and maintenance processes
  • Knowledge of highly managed specialty medications/strategy
  • Proficient in Microsoft office suite with emphasis on Microsoft excel
  • Experience working with large datasets preferred
  • 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

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


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Location

New York, NY

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