Manager, Clinical Operations

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 experiencing unprecedented growth, and we are looking for an exceptionally skilled and experienced Clinical Operations Manager to assume a crucial role in leading the Clinical Operations team and serving as the company's subject matter expert on operations support, including adjudication platform, clinical review operations and processes.

If you are a highly motivated Clinical Operations Manager, with a strong background in adjudication system related to claims processing and clinical review requirements, and are  driven to make a meaningful impact in the healthcare industry, we encourage you to apply.

What You'll Do:

• Function as the main point of contact for Clinical Concierge Services, ensuring the team effectively manages their caseload with timely and accurate execution while meeting their designated Key Performance Indicators (KPIs) and metrics.
• Manage the day-to-day functions within the Clinical Operations team and lead teams development towards delivering exceptional white-glove service.
• Serve as a subject matter expert on the adjudication system related to claims processing and clinical review processes.
• Effectively communicate and interact with all other EmpiRx Health departments in a manner that fosters teamwork and unity. Support team recruiting efforts by participating in the interview process for new hires.
• Ensure that daily processes and protocols are followed for case management and new staff training.
• Assist with handling escalations that cannot be resolved by the team or require supervisory action.
• Monitor the workload capacity of the Clinical Operations team and ensure their performance aligns with organizational KPIs.
• Ensure that best practices are maintained within the team to provide consistent high-quality concierge services.
• Strategically develop improved processes and streamline workstreams to increase efficiency.
• Provide effective support to the team as needed, including coverage and other responsibilities.

What you need:

• BS (Bachelor’s) Required
• Minimum 5 years of people management experience
• Minimum 5 years of pharmacy experience
• Minimum 2 years of experience in PBM, health plan, or equivalent
• Proficiency in Microsoft Office Suite

Preferred:

• Claim adjudication experience
• Remote people management

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 wellbeing and enhance your work-life balance:

• Medical, prescription, vision, dental, life, and disability insurance, with coverage for domestic partnerships.
• A 401K match program to secure your financial future.
• Parental leave for childbirth and adoption.
• Student loan reimbursement.
• Additional perks include flexible PTO, hybrid work arrangements, online wellness resources and counseling access, and an employee discount program.

Work Environment: Hybrid in Montvale, NJ.  We will consider remote for the right candidate.

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.

Compensation Structure

The compensation structure for this position at our company is governed by various state Fair Pay Acts. Salaries will vary based on multiple factors, including but not limited to professional and academic experience, training, associated responsibilities, and other business and organizational needs.  The range listed is just one component of our total compensation package for employees. 

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