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Clinical Operations Specialist

2 months ago

Montvale, United States EmpiRx Health Full time
Job DescriptionJob Description

Who We Are:
EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.

What We Do:
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients.
Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client management teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.

Who We're Looking For:

EmpiRx Health is experiencing unprecedented growth, and we're seeking a highly skilled and experienced clinical operations specialist.  In this critical role, you will ensure proficiency with the adjudication platform, understand claim processing, and provide clinical review support.  Clinic Ops staff must operate effectively for clients/members by assisting in support for overrides and clinical reviews promptly to ensure members are receiving white glove service.  Clinical Operations will closely and collaboratively work with a call center, clinical pharmacists, and other internal EmpiRx Health teams.

If you're a highly motivated Clinical Operations Specialist with a robust grasp of pharmacy adjudication processes and clinical review procedures and are eager to make a meaningful impact in the healthcare industry, we encourage you to apply.
 

What You'll Do:

As a Clinical Operations Specialist, your role will encompass a wide range of responsibilities:

  • Serve as an account support to internal EmpiRx Health teams for adjudication, clinical review, and claims support-related matters.
  • Ensure timely completion of day-to-day processes and assigned cases, adhering to standard operating procedures.
  • Address escalation requests within a targeted 2-hour turnaround time.
  • Manage claims override and prior authorization support, delivering exceptional white-glove service to clients and members.
  • Act as a subject matter expert on the adjudication platform, demonstrating a keen understanding of claims support.
  • Perform under the supervision of the ClinOps Manager and clinical pharmacists.
  • Effectively communicate and interact with all other EmpiRx Health departments, fostering teamwork and unity.

What You Need:

  • Minimum five years of pharmacy experience
  • CPhT certification
  • Minimum two years of claim adjudication experience
  • Minimum two years of prior authorization experience
  • Strong customer service orientation and commitment to delivering concierge-level service.
  • Ability to work in a fast-paced environment.
  • Time management skills with the ability to meet tight deadlines.
  • Excellent verbal and written communication skills
  • Proficient in Microsoft Office Suite
  • BS (Bachelor's) Preferred
  • Two years of experience in PBM, health plan, or equivalent preferred
  • Ability to work in office 5 days per week.
Why Join Us:
  • EmpiRx Health is on an extraordinary journey where excellence meets innovation.
  • We are a collaborative team that encourages groundbreaking ideas, values open dialogue, and prioritizes continuous improvement.
  • You will be part of a dynamic team where success is a shared celebration, collaboration fuels progress, and we redefine healthcare together.
  • We offer a generous and competitive benefits package.
  • You will share in the company's success through our discretionary bonus program.
EmpiRx Health is an Equal Opportunity Employer
EmpiRx Health is an equal opportunity employer. We are committed to creating a diverse and inclusive environment for all employees. We prohibit discrimination and harassment of any kind based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
All employment decisions are based on business needs, job requirements, and individual qualifications. We are an inclusive organization and actively promote equality of opportunity for all with the right mix of talent, skills and potential. EmpiRx Health celebrates diversity and is committed to creating an inclusive environment for all employees.
Your career at EmpiRx Health awaits – join us in shaping the future of excellence in healthcare.
Careers - EmpiRx Health

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