Clinical Operations Specialist

EmpiRx Health, LLC.; Montvale (NJ); On-site; USD 51,000 - 64,000; Full time

Benefits offered by this job

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Job summary

EmpiRx Health in Montvale, NJ, is seeking a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams, ensuring accurate processing of claims overrides and prior authorizations, and coordinating with stakeholders to sustain service excellence.

This full‑time, on‑site role requires 5+ years of pharmacy experience, including 2 years in claims adjudication and 2 in prior authorization, proficiency with Microsoft Office, and strong

Qualifications

• High school diploma required.
• Minimum 5 years of pharmacy experience, including at least 2 years in claims adjudication and 2 years in prior authorization processes.

Responsibilities

• Provide administrative and operational support to adjudication, prior authorization, and clinical review teams.
• Accurately process claim overrides and case documentation in accordance with SOPs.
• Ensure compliance with turnaround times and quality metrics to meet member and client expectations.
• Assist clinical pharmacists and operations teams with workflow management and reporting needs.
• Meet case completion targets and adhere to 2-hour SLA for escalation requests.
• Escalate high-priority or complex issues to leadership as needed.
• Collaborate with internal stakeholders to ensure efficient communication and case handling.

Skills

Microsoft Office Suite

Attention to detail

Customer service

Deadline management

Critical thinking

Education

High school diploma

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Clinical Operations Specialist

Full Time Montvale, NJ, Montvale, NJ, US

30+ days ago Requisition ID: 1268

Clinical Operations Specialist

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.

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 experience 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.

EmpiRx Health is in unprecedented growth, and we're seeking a highly skilled and experienced Clinical Operations Specialist. In this critical role, The Clinical Operations Specialist provides administrative and operational support to EmpiRx Health’s adjudication and clinical review teams. This role ensures accurate and timely processing of claims overrides and prior authorizations (PAs), contributing directly to service excellence and compliance. By enabling seamless collaboration between clinical and operational teams, the Clinical Operations Specialist upholds EmpiRx Health’s commitment to white-glove service and value-based pharmacy care delivery.

Key Responsibilities:

Operational Support

• Provide efficient administrative and operational support to adjudication, prior authorization, and clinical review teams.
• Accurately process claim overrides and case documentation in accordance with standard operating procedures (SOPs).
• Ensure compliance with all turnaround times and quality metrics to meet member and client expectations.
• Assist clinical pharmacists and operations teams with workflow management and reporting needs.
• Meet established case completion targets and maintain adherence to EmpiRx Health’s 2-hour SLA for escalation requests.
• Proactively monitor case queues to ensure timely follow-up and resolution.
• Escalate high-priority or complex issues promptly to leadership.
• Collaborate effectively with clinical pharmacists, call center representatives, and internal stakeholders to ensure efficient communication and case handling.
• Partner with internal departments, such as Member Services and Client Management, to deliver exceptional service and seamless issue resolution.
• Maintain a proactive and solutions-focused approach in all interactions.

Customer Service & Quality

• Demonstrate EmpiRx Health’s white-glove service standards in all communications and interactions with internal and external partners.
• Ensure precision, consistency, and adherence to defined processes in all assigned tasks.
• Identify opportunities to streamline administrative procedures and improve operational efficiency.

Adaptability & Communication

• Manage multiple priorities in a fast-paced, high-volume environment with professionalism and attention to detail.
• Communicate effectively in both written and verbal formats, ensuring clarity and accuracy.
• Maintain confidentiality and professionalism in all correspondence and case-related documentation.

Additional Responsibilities

• Perform additional duties as assigned by the Clinical Operations Manager or department leadership.
• Support special projects or workflow initiatives as directed.

Education Requirements:

• High school diploma required.

Licensure/Certifications

Required Qualifications & Experience:

• Minimum 5 years of pharmacy experience, including at least 2 years in claims adjudication and 2 years in prior authorization processes.
• 2 years of experience in a PBM, health plan, or related healthcare environment preferred.

Skills and Competencies:

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Exceptional attention to detail and organizational skills.
• Strong customer service orientation and interpersonal skills.
• Demonstrated ability to meet tight deadlines and manage multiple tasks efficiently.
• Strong critical thinking and problem-solving capabilities.
• Must be able to work on-site five days per week.

Work Environment: Fully On-Site in Montvale NJ, (5 Days per Week)

Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Student Loan Reimbursement, Health Savings Account, and an Employee Assistance Program.

The expected salary range for this New Jersey position is between $50,890 - $63,612. Total earnings may also include various incentive options. Actual pay will be adjusted based based on experience, education, geographic location, and other job-related factors as permitted by law. Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Tuition Reimbursement, Health Savings Account, and an Employee Assistance Program.

EmpiRx Health is an Equal Opportunity Employer

At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.

Note: This job description is a general outline of responsibilities and qualifications for the role. Additional duties may be assigned, and the position may evolve to meet the organization's needs.