Clinical Operations Specialist

Job Description

Job Description

Who We Are :

EmpiRx Health is a disruptor in an ever-changing healthcare industry, offering a market-differentiating, value-based pharmacy benefits management solution. We are bold and fearless in our approach to healthcare, how we talk about ourselves, and our use of advanced technology and analytics.

What We Do :

We partner with HR and Benefits managers nationwide to ensure our membership has access to the best pharmacy benefits available. 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. Our pharmaceutical staff daily consults with physicians to drive the greatest clinical and financial outcomes.

Employee-Centric Culture :

At EmpiRx Health, our employees are our most valuable asset. We've earned recognition as an award-winning leader in healthcare by investing in our employees. We are committed to fostering a culture of excellence and continuous improvement. Our approach to performance management is designed to empower employees to achieve their full potential while contributing to the overall success of the organization. Our leadership teams drive the employee experience with a strength-based learning and development approach. We've fostered an environment where every voice is heard, and talents are nurtured. At EmpiRx Health, we celebrate groundbreaking ideas, encourage collaboration, and value open dialogue.

Who We're Looking For :

EmpiRx Health is in unprecedented growth, and we're seeking a highly skilled and experienced Clinical Operations Specialist. In this critical role, you will ensure proficiency with the adjudication platform, understanding claim processing, and providing clinical review support. Clinic Ops staff must operate effectively for client / members by assisting in support for overrides and clinical reviews in a timely manner to ensure members are receiving white glove service. ClinOps will closely and collaboratively work with call center, clinical pharmacists, and other internal EmpiRx Health teams.

If you're a highly motivated Clinical Operations Specialist with a robust grasp of pharmacy adjudication processes and clinical review procedures, and you're eager to make a meaningful impact in the healthcare industry, we encourage you to apply.

What You'll Do :

As a Clinical Operations Specialist, your role will encompass a wide range of responsibilities :

• Serve as an account support to internal EmpiRx Health teams for adjudication, clinical review and claims support-related matters.
• Ensure timely completion of day-to-day processes and assigned cases, adhering to standard operating procedures.
• Address escalation requests within a targeted 2-hour turnaround time.
• Manage claims override and prior authorization support, delivering exceptional white-glove service to clients and members.
• Act as a subject matter expert on the adjudication platform, demonstrating a keen understanding of claims support.
• Perform under the supervision of the ClinOps Manager and clinical pharmacists.
• Effectively communicate and interact with all other EmpiRx Health departments in a manner that fosters teamwork and unity.

THIS ROLE IS IN OFFICE

What You Need :

Preferred :

Benefits and Perks :

At EmpiRx Health, we understand that a fulfilling career goes beyond the tasks at hand. It's about creating an environment where employees thrive both professionally and personally. As a valued member of our team, you'll have access to a range of benefits designed to support your overall well-being and enhance your work-life balance :

Join EmpiRx Health, where we are transforming the healthcare landscape with innovation and unwavering commitment to our employees and members. Make a difference and grow with us!

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.