Job Description
Position Summary:
We are seeking a strategic, detail-oriented professional to join our team, where you will utilize your expertise in formularies, rebates, and financial modeling to drive cost-effective solutions for our clients. In this role, you'll develop and present strategies that optimize formularies, identify cost-saving opportunities, and manage financial performance through data-driven analysis. You’ll also collaborate with both internal teams and clients, ensuring strategies are aligned and executed effectively. With strong project management skills, you’ll handle multiple requests while maintaining accuracy and ensuring compliance. This is a great opportunity for someone looking to make a significant impact in a dynamic and fast-paced environment, staying at the forefront of the pharmaceutical industry and its evolving landscape.
Position Responsibilities:
Utilize comprehensive understanding of clients’ formularies and rebates to develop and present strategies that that promote lowest net-cost options within specific therapeutic classes
Lead and develop financial modeling using client’s formulary and benefit structure to identify opportunities for formulary optimization that is based on various data sources, and utilization data
Develop repeatable methods to perform multiple analysis to compare and to evaluate the outcomes for each strategy
Create reporting standards to track financial performance of client adoption of strategies and summarize key metrics of progress
Leverage strong project management skills to manage multiple requests and have a sense for details that ensures accuracy of information
Align internal stakeholders on strategy and to present externally to clients
Stay up to date on the drug pipeline and its impact or forecasting potential impact on drug classes/rebates/utilization/modeling
Ensuring rebate compliance and clinical auditing of client custom formulary setup and UM criteria
Vendor relationship and management
Participate in quality performance initiatives
Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.
Required Qualifications:
Doctor of Pharmacy (PharmD) Degree from an accredited institution
Current, unrestricted registered pharmacist license(s)
Pharmacy experience working for a health plan or PBM preferred with a focus on formulary, utilization management, and rebate strategy
Possess a strong knowledge of drug therapeutics, disease state management, and treatment guidelines as part of the development of a clinical strategy
Leverage a deep knowledge of highly managed specialty medications/strategies, formulary development and maintenance processes, utilization management, and product pipeline to develop a formulary strategy
Understanding of financial arrangements within the landscape between pharmaceutical companies, PBMs, clients, payers, GPOs, aggregators, and members
Possess strong understanding of language criteria to develop rebate, formulary, and utilization management strategies
Proficient in Microsoft office Suite with emphasis on Microsoft Excel and PowerPoint
Ability to balance multiple complex projects simultaneously
Exceptional written and verbal communication skills
Ability to speak clearly and concisely, conveying complex or technical information to various audience type
Extremely flexible, highly organized, self-starter, and able to shift priorities easily
Attention to detail and commitment to delivering high quality work product
Proven ability to work well and collaboratively cross functionally, with multiple teams or departments in a fast-paced environment
Ability to travel
Preferred Qualifications:
Residency/fellowship preferred
Experience working with large datasets preferred
Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.
This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
About Capital Rx
Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare 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 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.
