Clinical Operations Specialist (Remote)

EmpiRx Health; Orlando (FL); Remote; USD 55,000 - 90,000; Full time

Job summary

An innovative healthcare firm is seeking a skilled Clinical Operations Specialist to join their dynamic team. In this fully remote position, you will play a crucial role in ensuring efficient pharmacy adjudication processes and providing top-tier clinical review support. The company values employee growth and offers a collaborative environment where your contributions can make a significant impact. With a commitment to excellence in member care and a focus on health outcomes, this is an exciting opportunity for those looking to thrive in the healthcare industry. Join a team that celebrates diversity and fosters a culture of continuous improvement, making a difference in the lives of many.

Benefits

Medical Insurance

401K Match Program

Parental Leave

Student Loan Reimbursement

Flexible PTO

Hybrid Work Arrangements

Online Wellness Resources

Counseling Access

Employee Discount Program

Qualifications

• 5+ years of pharmacy experience with a focus on claims and clinical review.
• Strong customer service skills and ability to work under pressure.

Responsibilities

• Provide support for adjudication and clinical reviews, ensuring timely processes.
• Manage claims overrides and deliver exceptional service to clients and members.

Skills

Pharmacy Experience

Claim Adjudication

Prior Authorization

Customer Service Orientation

Time Management

Verbal Communication

Written Communication

Education

Bachelor's Degree (Preferred)

Tools

Microsoft Office Suite

Job description

Who We Are
EmpiRx Health is a disruptor in an ever-changing healthcare industry, offering a market-differentiating, value-based pharmacy benefits management solution. We are bold and fearless in our approach to healthcare, how we talk about ourselves, and our use of advanced technology and analytics.

What We Do
We partner with HR and Benefits managers nationwide to ensure our membership has access to the best pharmacy benefits available. 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. Our pharmaceutical staff daily consults with physicians to drive the greatest clinical and financial outcomes.

Employee-Centric Culture
At EmpiRx Health, our employees are our most valuable asset. We've earned recognition as an award-winning leader in healthcare by investing in our employees. We are committed to fostering a culture of excellence and continuous improvement. Our approach to performance management is designed to empower employees to achieve their full potential while contributing to the overall success of the organization. Our leadership teams drive the employee experience with a strength-based learning and development approach. We've fostered an environment where every voice is heard, and talents are nurtured. At EmpiRx Health, we celebrate groundbreaking ideas, encourage collaboration, and value open dialogue.

Who We're Looking For
EmpiRx Health is in unprecedented growth, and we're seeking a highly skilled and experienced Clinical Operations Specialist. In this critical role, you will ensure proficiency with the adjudication platform, understanding claim processing, and providing clinical review support. Clinic Ops staff must operate effectively for client/members by assisting in support for overrides and clinical reviews in a timely manner to ensure members are receiving white glove service. ClinOps will closely and collaboratively work with call center, clinical pharmacists, and other internal EmpiRx Health teams.

If you're a highly motivated Clinical Operations Specialist with a robust grasp of pharmacy adjudication processes and clinical review procedures, and you're eager to make a meaningful impact in the healthcare industry, we encourage you to apply.

What You'll Do
As a Clinical Operations Specialist, your role will encompass a wide range of responsibilities:

• Serve as an account support to internal EmpiRx Health teams for adjudication, clinical review and claims support-related matters.
• Ensure timely completion of day-to-day processes and assigned cases, adhering to standard operating procedures.
• Address escalation requests within a targeted 2-hour turnaround time.
• Manage claims override and prior authorization support, delivering exceptional white-glove service to clients and members.
• Act as a subject matter expert on the adjudication platform, demonstrating a keen understanding of claims support.
• Perform under the supervision of the ClinOps Manager and clinical pharmacists.
• Effectively communicate and interact with all other EmpiRx Health departments in a manner that fosters teamwork and unity.
• Role is 100% remote work from home.

What You Need

• Minimum 5 years of pharmacy experience.
• Minimum 2 years of claim adjudication experience.
• Minimum 2 years of prior authorization experience.
• Strong customer service orientation and commitment to delivering concierge-level service.
• Ability to work in a fast-paced environment.
• Time management skills with the ability to meet tight deadlines.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office Suite.

Preferred:

• BS (Bachelor’s) Preferred.
• 2 years of experience in PBM, health plan, or equivalent.

Benefits and Perks:
At EmpiRx Health, we understand that a fulfilling career goes beyond the tasks at hand. It's about creating an environment where employees thrive both professionally and personally. As a valued member of our team, you'll have access to a range of benefits designed to support your overall well-being and enhance your work-life balance:

• Medical, prescription, vision, dental, life, and disability insurance, with coverage for domestic partnerships.
• A 401K match program to secure your financial future.
• Parental leave for childbirth and adoption.
• Student loan reimbursement.
• Additional perks include flexible PTO, hybrid work arrangements, online wellness resources, and counseling access, and an employee discount program.

Join EmpiRx Health, where we are transforming the healthcare landscape with innovation and unwavering commitment to our employees and members. Make a difference and grow with us!

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.

Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Research, Analyst, and Information Technology

Industries

Hospitals and Health Care

Third party solicitation, submission, and referrals of applicants for this role will not be considered.