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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.

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Clinical

Quality Assurance Technician

Position Responsibilities:

• Perform monthly performance audits, end-to-end audits, and ad hoc audit requests for the Prior Authorization pharmacy technician team.?

• Respond to inquiries from internal and external customers regarding quality review and compliance policy and procedures.

• Evaluate audit findings and identify areas requiring additional audit review

• Assist in designing and implementing audit tools and programs, working?with operations team to create/update QA scorecard/audit tool.?

• Assist in the development of prior authorization technician performance and quality metrics.

• Communicate audit results and identified issues to multiple levels of leadership.?

• Provide ongoing performance feedback to team leadership to ensure consistent performance adherence to departmental procedures and regulatory requirements (URAC, NCQA).

• Assist management in identifying, evaluating, and mitigating operational, and compliance risks.

• Work in collaboration with operational leaders to identify training opportunities and recommend improvements to Work Instructions, Job Aids, and Policy and Procedures to improve performance.

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.

• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.

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

Required Qualifications:

• 4+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting

• 2+ years of auditing, training, or leadership experience

• Experience handling prior authorization requests/understanding of prior authorization requirements required

• National Certified Pharmacy Technician (CPhT) license required

• Bachelor’s degree is preferred

• Possess strong analytical skills, attention to detail, quantitative, and problem-solving abilities.?

• Proficient in Excel

• Familiarity with regulatory requirements (URAC, NCQA)

• Excellent communication, writing, and organizational skills

• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment

• Ability to multi-task and collaborate in a team with shifting priorities

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.

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