Population Health Executive - Hybrid PBM Clinical Leader

EmpiRx Health, LLC.

Montvale (NJ)

Hybrid

USD 125,000 - 155,000

Full time

3 days ago

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Benefits offered by this job

Paid Time Off

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 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

Qualifications

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.

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.