Director, Clinical Client Operations, PBA Services

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
• Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations
• Create and improve scalable processes to ensure interpretation of clinical trends, relevant pharmacy data, and to provide recommendations with supportive rationale for clinical management strategies supporting our PBA account growth and retention efforts.
• Provide ongoing direction, mentoring, coaching to team and provide feedback for individual associate growth and development
• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Doctor of Pharmacy (PharmD) degree, required
• Current, unrestricted registered pharmacist license(s)
• Relevant experience of 5-7 years in health plan, managed care, or pharmacy benefits management (PBM) settings, required
• Prior clinical account management experience of at least three (3) years, required
• Exceptional written and verbal communication skills
• Leadership and relationship building skills required for success
• Ability to balance multiple complex projects simultaneously
• Flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel
• Experience working with large datasets and analyzing raw data in Excel
• Ability to travel and present to small and large groups

Preferred Qualifications:

• Completion of managed care residency, preferred
• Prior experience leading a clinical team and developing talent
• Prior experience with Medicare line of business, preferred

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.