Clinical Account Consultant, PBA

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,

• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and

• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Position Summary:

Capital Rx is seeking a strategic, client-focused Clinical Account Consultant to support all aspects of clinical functions to service client clinical needs. In this role, you'll ensure client satisfaction, retention, and trend management, while providing clinical support to clients across all lines of business. You’ll collaborate directly with clients to develop and implement formulary and clinical strategies, support contract renewals, and contribute to clinical process improvements. If you’re passionate about delivering exceptional service with a focus on clinical excellence and driving healthcare innovation, we’d love to hear from you!

Position Responsibilities:

• Support clinical aspects of implementation for new clients, plans, plan changes, and other clinical plan set-up requirements. This may include gathering client clinical intent and plan requirements, building/coding plans and formularies, conducting peer-review quality control, and reviewing testing and claims output.

• Actively address all clients’ clinical needs including the management and implementation of custom formularies, clinical criteria, and clinical strategies.

• Comprehend and effectively explain formulary, benefit, and clinical programs to clients, including intervention components, member and plan experience, book of business experience, and regulatory requirements as it directly pertains to clinical functions.

• Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for formulary, clinical and plan management strategies.

• Analyze and interpret pharmacy claims data to identify clinical and plan trends and to offer insights for individual clients and across multiple clients.

• Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries.

• Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations.

• Actively attend and contribute to sales meetings and client presentations with a focus on clinical operations and clinical account management.

• Lead key internal clinical operations initiatives and general business needs/operations, as required.

• Identify and contribute to clinical process improvement efforts.

• Certain times of year may require meeting participation, testing, claims review, or other requirements outside of standard business hours, including weekends.

• 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)

• Relevant experience of 3-5 years in a health plan or pharmacy benefits management (PBM)

• Direct account management experience supporting clients across multiple lines of business

• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel

• Experience working with large datasets and analyzing raw data in Excel

• Ability to balance multiple complex projects simultaneously

• Exceptional written and verbal communication skills

• Flexible, highly organized, and able to shift priorities easily

• Attention to detail & commitment to delivering high quality work product

• Ability to travel and present to small and large groups

Preferred Qualifications:

• Completion of managed care residency, preferred

• Prior account management experience of at least three (3) years, preferred

• 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.

Salary Range
$145,000—$165,000 USD

All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. 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.

Judi Health 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.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.