Job 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 expecting unprecedented growth, and we're seeking a highly skilled and experienced Clinical Pharmacist.  In this critical role, you will ensure clinical prior authorization and appeal determinations in accordance with covered plan design while ensuring clinically appropriate pharmacy care and deep and sustainable clinical savings for our clients. 

If you are a highly motivated Clinical Pharmacist with a strong background in comprehensive case review and direct physician engagement, and you are passionate about making a meaningful impact in the healthcare industry, we encourage you to apply.

What You'll Do:

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

• Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.  
• Review, evaluate, and resolve all assigned clinical reviews through comprehensive case review and highlight our Population Health Management model with direct physician engagement.
• Subject matter expert on the EmpiRx Health Population Health Management Model
• Review and evaluate clinical literature resources to support decision-making and recommendations to providers. 
• Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met. 
• Perform peer-to-peer reviews with providers on identified cases or when requested. 
• Provide guidance and support to members, providers, and other healthcare providers on clinical-related inquiries.
• Collaborate with clinical technicians, prior authorization team members to facilitate clinical review requests, answer questions and/or resolve escalations.  
• Convey clinical determinations promptly within established turnaround time requirements to prescribers, members and other healthcare professionals following agreed-upon approval, denial processes. 
• Participate in continuous quality improvement efforts to streamline the clinical review process and enhance member care.  
• Stay updated with changes in pharmacy practice and industry regulations through continuing education and professional development.  
• Stay informed about EmpiRx Health formulary changes, clinical programs, and internal policies. 
• Act as a clinical resource for internal staff and support staff training/development as required.  
• Proficiently utilize pharmacy management software for documentation and communications.  
• Proficiently utilize Microsoft Office tools.  
• Utilize external clinical and drug information tools to support clinical reviews and decision making as well as to stay abreast of current drug pipeline (e.g., IPD, Policy Reporter, UpToDate, and MediSpan) 
• Collaborate with internal clinical team and cross-functional teams to provide clinical support and guidance, as needed, including but not limited to claim/data review, clinical interventions, and provider/member/client support as required. 

What You Need:

• 3+ years of pharmacy experience
• PharmD (required) 
• Active pharmacist license
• Exceptional written and verbal communication skills
• Experienced in Microsoft Office Suite; prescription medication analysis.
• PBM/Health Plan experience evaluating and reviewing Prior Authorization preferred
• Specialty Pharmacy experience preferred
• MTM certification or other specialty certifications preferred

  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

**No recruiters, please**

 

Job Tags

Full time, Local area,

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