Population Health Clinical Executive

Key Responsibilities

• RXCurve 360 Ticket Management, High-Cost Case Reviews & Intervention Execution
• 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.
• Clinical Tracker Maintenance & Reporting
• Accurately reconcile clinical interventions and updates within the clinical savings trackers.
• Ensure interventions are properly categorized and aligned with clinical savings methodologies.
• Collaborate with the Population Health Clinical Manager and Director of Clinical Risk and Management to reconcile clinical savings reporting.
• Clinical Account Executive Support
• Cross-trained in CAE functions to support team members during peak demand, ensuring seamless operations and maintaining productivity across teams.
• Provide support to clients on an as needed basis, ensuring continuity of service when primary CAE is unavailable (e.g. client meeting, client/member requests).
• Follow established workflows and standard operating procedures to ensure consistency, quality, and compliance in clinical interventions.
• Provide feedback on workflow challenges and opportunities for enhancements to the Population Health Clinical Manager.
• Clinical Pharmacist – Prior Authorization Support
• Cross-trained in Clinical Pharmacist functions to support team members during peak demand, ensuring seamless operations and sustained productivity across clinical teams.
• Provide coverage for clinical prior authorization and appeal reviews, making determinations in accordance with covered plan design while ensuring clinically appropriate pharmacy care and driving sustainable clinical savings for clients.
• Follow established workflows and standard operating procedures to ensure consistency, quality, compliance, and timely communication of clinical determinations.

Skills

• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and prioritize clinical interventions effectively.
• Excellent clinical judgment and problem-solving skills.
• Proficiency with Microsoft Excel, Word, and PowerPoint; familiarity with RXCurve or other clinical tracking systems preferred.
• Strong written and verbal communication skills.
• Analytical mindset with the ability to identify and support clinical savings opportunities.
• Team-oriented, proactive, and solutions-focused approach.

Qualifications & Experience

• 3+ years of experience in pharmacy benefit management (PBM), healthcare operations, clinical case management, or similar clinical roles.
• Experience with clinical interventions, formulary management, or healthcare reporting processes preferred.
• Licensure/ Certifications: Active Pharmacist License in good standing (Required); Board Certification (e.g., BCPS, BCACP, BCOP) preferred.

Work Environment

Hybrid, Montvale, NJ

Pay Range

$125,00 - $155,00

Benefits

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

Equal Opportunity Employer

EmpiRx Health is an Equal Opportunity Employer.