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.

Position Summary:

The Clinical Pharmacy Services department provides clinical business support to the entire enterprise and provides clinical support for Capital Rx’s clinical prior authorization programs, consultative support to the P&T process, formulary development, drug information services and client activities as assigned. This position will report to Chief Clinical Officer. This position transacts UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to Capital Rx’s coverage policies. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a stakeholder across the enterprise.

We are hiring for two part-time shifts, both M-F: 7 am-11 am EST and 6 pm-10 pm EST

Position Responsibilities:

• Director will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate
• Makes clinical determinations in accordance with medical necessity and criteria
• Performs scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribers
• Support the Department’s responsibilities to provide peer-to-peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisions
• Communicates effectively and confidently with members to promote positive health outcomes
• Actively participates in the development of utilization management (PA) criteria and clinical policy revisions/reviews
• Ability to work in a fast-paced environment with shifting priorities

Qualifications / Profile:

• Must be graduate of an accredited Medical School and Residency Program
• Texas medical license, required
• ABMS or AOA Board Certified in a Primary Care field (Internal medicine, Family Medicine) or a specialty within Internal Medicine such as Cardiology, Rheumatology, or Endocrinology, required
• Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employment
• Demonstrated experience in clinical outcomes, working knowledge of medical statistics, regulatory agencies, and analytic programs
• Ability to work with virtual teams of pharmacists to develop clinical programs/guidance for physicians and other prescribers
• Management and time management skills to meet competing priorities and organizational goals
• Knowledge of PBM environment, quality improvement and UM practices in a managed care environment
• Knowledge of and appreciation for requirements of regulatory and accreditation agencies
• Able to manage multiple priorities and deadlines
• Excellent verbal, written, interpersonal and presentation skills
• Strong knowledge of clinical medicine, health care delivery and the ability to acquire new scientific and medical knowledge
• Proficiency with Microsoft Office applications. (e.g., MS Word, Excel, and PowerPoint minimum)
• Understanding of the Project management process and proven experience in staff and budget management is strongly desirable

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

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.