Clinical Care Pharmacist

Position Summary: The Clinical Care Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service excellence in a fast-paced, collaborative environment. Position Responsibilities: • Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria. • Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans. • Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards. • Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach. • Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities. • Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security. • Identify and report potential fraud, waste, and abuse. • Support training and development of new and existing team members as needed. • Assist leadership with special projects, process improvements, and operational initiatives Minimum Qualifications: • Active, unrestricted, pharmacist license • Bachelor’s or Doctor of Pharmacy degree • Minimum of 2 years of pharmacy practice experience • Experience in managed care or pharmacy benefit management (PBM) • Strong communication, writing, and organizational skills • Ability to manage multiple priorities in a high-volume, metric-driven environment • Availability to work after hours, weekends, and holidays on a rotating schedule Preferred Qualifications: • Prior authorization experience • Call center experience This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary Range $135,000—$145,000 USD About Capital Rx Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare. Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Apply tot his job Apply To this Job