On-Site Clinical Operations Specialist — PBM Impact

EmpiRx Health; Orlando (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Job summary

EmpiRx Health is seeking a Clinical Operations Specialist to provide cross-functional, on-site support to adjudication, prior authorization, and clinical review teams. You will help manage workflows, process cases, and ensure timely, accurate documentation.

The role requires a minimum of five years in pharmacy with claims and prior authorization experience, a CPhT credential, and strong Microsoft Office skills.

Qualifications

• Minimum 5 years of pharmacy experience, including at least 2 years in claims adjudication and 2 years in prior authorization.
• 2 years of experience in a PBM, health plan, or related healthcare environment preferred.
• Certified Pharmacy Technician (CPhT) is required.
• Active Pharmacy Technician License preferred.

Responsibilities

• Provide efficient 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.
• Collaborate with clinical pharmacists, call center representatives, and internal stakeholders to ensure efficient communication and case handling.
• Maintain confidentiality and professionalism in all correspondence and case-related documentation.

Skills

Microsoft Office

Attention to detail

Customer service

Deadline management

Time management

Problem solving

Communication

Education

High school diploma

Bachelor’s degree preferred

Job description

EmpiRx Health is seeking a Clinical Operations Specialist to provide cross-functional, on-site support to adjudication, prior authorization, and clinical review teams. You will help manage workflows, process cases, and ensure timely, accurate documentation.

The role requires a minimum of five years in pharmacy with claims and prior authorization experience, a CPhT credential, and strong Microsoft Office skills.