Clinical Operations Specialist

About the company

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.

About the role

The Clinical Operations Specialist provides administrative and operational support to EmpiRx Health’s adjudication and clinical review teams. This role ensures accurate and timely processing of claims overrides and prior authorizations (PAs), contributing directly to service excellence and compliance. By enabling seamless collaboration between clinical and operational teams, the Clinical Operations Specialist upholds EmpiRx Health’s commitment to white-glove service and value-based pharmacy care delivery.

Responsibilities

• Provide efficient administrative and operational support to adjudication, prior authorization, and clinical review teams.
• Accurately process claim overrides and case documentation in accordance with standard operating procedures (SOPs).
• Ensure compliance with all turnaround times and quality metrics to meet member and client expectations.
• Assist clinical pharmacists and operations teams with workflow management and reporting needs.
• Meet established case completion targets and maintain adherence to EmpiRx Health’s 2-hour SLA for escalation requests.
• Proactively monitor case queues to ensure timely follow-up and resolution.
• Escalate high-priority or complex issues promptly to leadership.
• Collaborate effectively with clinical pharmacists, call center representatives, and internal stakeholders to ensure efficient communication and case handling.
• Partner with internal departments, such as Member Services and Client Management, to deliver exceptional service and seamless issue resolution.
• Demonstrate EmpiRx Health’s white-glove service standards in all communications and interactions with internal and external partners.
• Ensure precision, consistency, and adherence to defined processes in all assigned tasks.
• Identify opportunities to streamline administrative procedures and improve operational efficiency.
• Manage multiple priorities in a fast-paced, high-volume environment with professionalism and attention to detail.
• Communicate effectively in both written and verbal formats, ensuring clarity and accuracy.
• Maintain confidentiality and professionalism in all correspondence and case-related documentation.
• Perform additional duties as assigned by the Clinical Operations Manager or department leadership.
• Support special projects or workflow initiatives as directed.

Requirements

• High school diploma required; Bachelor’s degree preferred.
• Certified Pharmacy Technician (CPhT) required; active Pharmacy Technician License preferred.
• Minimum 5 years of pharmacy experience, including at least 2 years in claims adjudication and 2 years in prior authorization processes.
• 2 years of experience in a PBM, health plan, or related healthcare environment preferred.

Skills

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Exceptional attention to detail and organizational skills.
• Strong customer service orientation and interpersonal skills.
• Demonstrated ability to meet tight deadlines and manage multiple tasks efficiently.
• Strong critical thinking and problem-solving capabilities.
• Must be able to work on-site five days per week.

Schedule

Monday – Friday | 8:30 AM – 5:00 PM EST

Work Environment

Fully on-site in Montvale, NJ (5 days per week).

Pay

The expected salary range for this New Jersey position is between $50,890 - $63,612. 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.

Benefits

• Paid Time Off
• 401(k) program
• Health Insurance including Dental & Vision coverage
• Student Loan Reimbursement
• Tuition Reimbursement
• Health Savings Account
• Employee Assistance Program