Population Health Clinical Executive

EmpiRx Health; Montvale (NJ); Hybrid; USD 125,000 - 155,000; Full time

Benefits offered by this job

Paid Time Off

a 401(k) program

Health Insurance including Dental &amp

Vision coverage

Health Savings Account

Employee Assistance Program.

Student Loan Reimbursement

Job summary

EmpiRx Health in Montvale, NJ is seeking a Population Health Clinical Executive to lead clinical interventions within the Care Management department. You will monitor RXCurve tickets, review high-cost cases, engage physicians, and document savings opportunities to support our value-based model.

The role collaborates with CAEs, Prior Authorization, CPTs, Analytics, and others to drive outcomes, maintain compliance, and ensure timely clinical determinations.

Qualifications

• 3+ years of experience in PBM, healthcare operations, clinical case management, or similar roles.
• Experience with clinical interventions, formulary management, or healthcare reporting.
• Active Pharmacist License in good standing.

Responsibilities

• RXCurve 360 Ticket Management, High-Cost Case Reviews & Intervention Execution.
• Review High-Cost case tickets and ensure timely completion of reviews.
• Document clinical interventions and savings opportunities for reporting.
• Assist with clinical prior authorization and appeals reviews as needed.
• Collaborate with Population Health Manager and cross-functional teams to improve outcomes.

Skills

Attention to detail

Organizational skills

Multitasking

Clinical judgment

Microsoft Excel

PowerPoint

Verbal and written communication

Analytical mindset

Team-oriented

Education

PharmD

Tools

RXCurve

Microsoft Excel

Microsoft Word

PowerPoint

Job description

• Active Pharmacist License in good standing (Required)

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

• RXCurve 360 Ticket Management, High-Cost Case Reviews & Intervention Execution


• 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.


• Clinical Pharmacist – Prior Authorization Support


• 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

• Active Pharmacist License in good standing (Required)


• 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


• Employee Assistance Program.)

Benefits And Perks

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


• 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.