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.

Prior Authorization & Customer

Supervisor, Clinical Prior Authorization Technician

Location: Remote

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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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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• Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process.
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• Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance.
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• Actively participate in the prior authorization technician metric and quality goal setting process.
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• Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders.
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• Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees.
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• Investigate/resolve escalated issues or problems from team members, clients, and other internal teams.
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• Maintain relationships with external Independent Review Organizations and clinical resource vendors.
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• Support the training and growth of both new and existing staff members in adherence to proper procedures.
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• Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties.
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• Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department.
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• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
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• Maintain compliance with local, state, and federal laws, in addition to established organizational standards.
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• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
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• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
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• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
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Required Qualifications:

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• Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
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• Bachelor’s or Associate’s degree is preferred
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• 4+ years of PBM or Managed Care pharmacy experience required
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• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
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• Strong clinical background required
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• Excellent communication, writing, and organizational skills
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• Ability to multi-task and collaborate in a team with shifting priorities
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Base Salary: $80,000 - $85,000

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.