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.

Apply For This Position

Clinical

Formulary Operations Clinical Pharmacist

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

This is a temporary 5-6 month assignment as a Formulary Operations Clinical Pharmacist. This role is responsible for managing and maintaining Capital Rx's standard and custom client formularies in the formulary management tool and adjudication platform. The role will include ensuring all assigned formularies are accurately coded, configured, and tested in a timely manner. Additionally, the role will support operational initiatives and projects that assist in the development of programs and processes for formulary management.

Position Responsibilities:

• Define, develop, and maintain standard commercial and exchange (health insurance marketplace) line of business formularies

• Lead monthly, quarterly, and annual formulary change processes within URAC/NCQA/QHP guidelines

• Define, develop, and maintain clinical adjudication drug lists; perform weekly, monthly, quarterly, and annual review and maintenance

• Lead the medical and pharmacy drug pipeline process by monitoring drugs in development and new drug approvals, proactively monitoring relevant publicly available news/developments, and analyzing drugs and emerging therapeutics, including financial forecasts

• Monitor and analyze regulatory and legislative requirements for the commercial and exchange (health insurance marketplace) line of business, develop project plans to meet requirements, and lead cross functional teams to implement programs to meet requirements

• Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literature

• Analyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management edits

• Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies

• Maintain and update the Capital Rx pharmaceutical pipeline, as required

• Develop clinical criteria for review of non-formulary or non-preferred drug lists as needed

• Support quality improvement projects as required

• Support RFI and RFP submissions, as required

• Support general business needs and operations, as required

• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Minimum Qualifications:

• Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance

• Current, unrestricted registered pharmacist license(s)

• Microsoft office suite with emphasis on Microsoft excel proficiency required

• Knowledge of the formulary development and maintenance processes

• Knowledge of highly managed specialty medications/strategy

• Knowledge of rebate and financials implications of formulary strategies

• Ability to balance multiple complex projects simultaneously

• Resourceful and can work independently

• 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

Preferred Qualifications:

• Residency/fellowship preferred

• 1-2 years of formulary experience working for a health plan or PBM preferred

• Experience working with large datasets preferred

Hourly Rate: $58-62/hr

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-AW1

Apply For This Position