Director, Clinical Client Operations, PBA Services

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.

Location: Remote (For Non-Local) with client and sales travel 

Position Overview: 

The Director, Clinical Client Operations – PBA Services oversees the Clinical Account Consultant team and is responsible for ensuring the consistent implementation and delivery of all clinical operations across Pharmacy Benefit Administration (PBA) market segments including Health Plans, Third Party Administrators (TPAs), and other Platform services.  The role spans multiple functions including benefit and formulary strategy and operations, clinical program management, and requires the development of analytical skills to ensure clinical trend and pipeline management. An ideal candidate possesses both strong operational and client management expertise, can work cross functionally with both internal and external stakeholder, effectively lead a team to reach company/department organization goals, and maintain client satisfaction and retention.  

Position Responsibilities: 

• Actively partner with the broader account management team to provide best-in-class member and client service for complex clients to meet client objectives, client priorities and service model deliverables  
• Provide oversight and direction of the clinical account consultant team with a specialized focus on account clinical operations, clinical programs, clinical formulary & utilization management, government programs, and trend management and regulatory compliance 
• Comprehend and effectively explain formulary and utilization management, benefit, and clinical strategies to team, including member, book of business, and competitive market experience 
• Identify and lead resolution efforts for escalated clinical client operations, clinical member and clinical issues that may have multiple client(s) impacted  
• Serve as a liaison between Clinical Account Consultants and internal leaders/departments to develop organizational initiatives and roadmaps to support strategic PBA accounts and their clinical needs 
• Collaborate with internal teams to lead and drive executions of client customizations of clinical offerings and solutions, to align with Health Plan/TPA Account needs and market demands 
• Develop and maintain comprehensive knowledge of our business, including clinical products, services, and processes to address client inquiries timely and accurately 
• Analyze and interpret current pharmacy and healthcare trends, competitor activities, and regulations to inform strategic clinical insights that provide proactive recommendations for plan management and enhance the company's positioning within the PBA Services segment 
• Lead, coach and support the Clinical Account Team on the effective positioning of Capital Rx’s value proposition and our suite of clinical and non-clinical products 
• Partner with our broader Account Management team to support our PBA account growth and retention efforts by providing clinical support and positioning Capital Rx market differentiators