Population Health Clinical Executive

EmpiRx Health, LLC.; Montvale (NJ); Híbrido; USD 125.000 - 155.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Vision coverage

Health Savings Account

Employee Assistance Program

Student Loan Reimbursement

Descripción de la vacante

EmpiRx Health in Montvale, NJ is seeking a Population Health Clinical Executive to lead clinical interventions and ensure alignment with our value-based care model. This role focuses on overseeing RxCurve tickets, reviewing high-cost cases, and documenting savings opportunities.

You will collaborate with CAEs, Clinical Manager, analytics, and other stakeholders to drive outcomes and performance. The position is hybrid in Montvale and offers opportunities to influence clinical strategy while

Formación

• 3+ years of experience in PBM, healthcare operations, clinical case management, or similar clinical roles.
• Experience with clinical interventions, formulary management, or healthcare reporting processes preferred.

Responsabilidades

• Proficiency with the EmpiRx Health Population Health Management Model, Johns Hopkins ACG risk stratification, member and physician profiling and intervention opportunity rules.
• Review and resolve all assigned RxCurve360 tickets utilizing case priority scoring through comprehensive case review and direct physician engagement.
• Review High-Cost case tickets/cases in Tredium/JMT and ensure timely completion of reviews.
• Review clinical cases as part of the Clinical Quality Improvement Committee.
• Document case studies that are triggered by our Population Health Engine and highlight our clinical model with direct physician engagement towards lower cost clinically appropriate care.

Conocimientos

Attention to detail

Multitasking

Clinical judgment

Communication skills

Analytical mindset

Team-oriented

Educación

PharmD

Herramientas

RXCurve

Excel

Word

PowerPoint

Descripción del empleo

Population Health Clinical Executive

Full Time Montvale, NJ, Montvale, NJ, US

Population Health Clinical Executive

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 Population Health Clinical Executive. The Population Health Clinical Executive plays a key role within the Care Management department, responsible for the timely and accurate execution of clinical interventions aligned with EmpiRx Health’s value-based model.

This role focuses on monitoring and managing RXCurve tickets, review of high-cost cases, executing clinically appropriate interventions, documenting savings opportunities, and supporting data tracking and reporting efforts.

The Population Health Clinical Executive collaborates closely with the Population Health Clinical Manager, Clinical Account Executives (CAEs), Prior Authorization, Clinical Pharmacy Technicians (CPTs), Analytics, and other internal stakeholders to drive clinical outcomes and operational excellence.

Key Responsibilities:

• Proficiency with the EmpiRx Health Population Health Management Model, Johns Hopkins ACG risk stratification, member and physician profiling and intervention opportunity rules.
• Review and resolve all assigned RxCurve360 tickets utilizing case priority scoring through comprehensive case review and direct physician engagement.
• Review High-Cost case tickets/cases in Tredium/JMT and ensure timely completion of reviews.
• Review clinical cases as part of the Clinical Quality Improvement Committee.
• Document case studies that are triggered by our Population Health Engine and highlight our clinical model with direct physician engagement towards lower cost clinically appropriate care.

Clinical Tracker Maintenance & Reporting

• Accurately reconcile clinical interventions and updates within the clinical savings trackers.
• Ensure interventions are properly categorized and aligned with clinical savings methodologies.
• Collaborate with the Population Health Clinical Manager and Director of Clinical Risk and Management to reconcile clinical savings reporting.

Clinical Account Executive Support

• Cross-trained in CAE functions to support team members during peak demand, ensuring seamless operations and maintaining productivity across teams.
• Provide support to clients on an as needed basis, ensuring continuity of service when primary CAE is unavailable (e.g. client meeting, client/member requests)
• Follow established workflows and standard operating procedures to ensure consistency, quality, and compliance in clinical interventions.
• Provide feedback on workflow challenges and opportunities for enhancements to the Population Health Clinical Manager.
• Cross-trained in Clinical Pharmacist functions to support team members during peak demand, ensuring seamless operations and sustained productivity across clinical teams.
• Provide coverage for clinical prior authorization and appeal reviews, making determinations in accordance with covered plan design while ensuring clinically appropriate pharmacy care and driving sustainable clinical savings for clients.
• Follow established workflows and standard operating procedures to ensure consistency, quality, compliance, and timely communication of clinical determinations.

Skills:

• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and prioritize clinical interventions effectively.
• Excellent clinical judgment and problem-solving skills.
• Proficiency with Microsoft Excel, Word, and PowerPoint; familiarity with RXCurve or other clinical tracking systems preferred.
• Strong written and verbal communication skills.
• Analytical mindset with the ability to identify and support clinical savings opportunities.
• Team-oriented, proactive, and solutions-focused approach

Education: PharmD

Required Qualifications & Experience:

• 3+ years of experience in pharmacy benefit management (PBM), healthcare operations, clinical case management, or similar clinical roles.
• Experience with clinical interventions, formulary management, or healthcare reporting processes preferred.

Licensure/ Certifications:

• Board Certification (e.g., BCPS, BCACP, BCOP) preferred

Work Environment: Hybrid, Montvale, NJ

The expected salary range for this New Jersey position is between $125,00 - $155,00. Total earnings may also include various incentive options. Actual pay will be adjusted 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, Health Savings Account, and an Employee Assistance Program.)

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.

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.