Mark Powers

New Job! They want to hire 2-4+ more contractors to start with their last training class 12/8. Time is limited and with the holiday next week they are hoping they can have offers out and backgrounds submitted by 11/25! HCS Job Title: Prior Authorization Pharmacist Company Job Title: Clinical Care Prior Authorization Pharmacist Working with Hiring Managers Lorece Shaw, Nicole Etti and Brittany Moore and TA’s Grant Rose and Ben Caggia Vaccination NOT REQUIRED # of Openings:  2-4+ If Contract, Length of Assignment:  RTH (will be based on performance and business need, not all will be eligible to convert but will be converting top performers) MU or BR:  42.5% MU Compensation Notes:  $125k per year  - Please note these are salary exempt - will not get paid for working overtime Location:  Remote nationwide except for these states: Alaska, Mississippi, Montana, South Dakota, Vermont and West Virginia Shift: M-F 11am-8pm or 2pm-11pm. May also have 7am-4pm shift. Will have rotating weekend coverage every 3-4 weeks after training (depending on business need) and will need to work both Saturday and Sunday but will have Friday and Monday off. Weekend shift will be 8am-5pm Start Date: 12/8/2024 Interview Times/Interviewer: Virtual with Lorece Shaw and hiring team Minimum Education/Licensures/Qualifications: Must include city and state on resume

• Please include in relevant skill set and each position it applies if they have reviewed and either approved or denied authorizations and how many authorizations did they complete per hour or per day on average?
• Please use resume template uploaded to files and include interview availability for the next 1-2 weeks at the top and if they have a shift preference or flexible to both (just need name and email for submittal)
• Available to work the later schedules listed and weekend coverage
• Comfortable with being salary exempt (will not get paid overtime but if they work less than 40 eligible to get paid for some of the missed time)
• They partner with Prime Therapeutics, can’t submit anyone who has worked there within the last year to avoid conflict of interest
• If they have applied to Capital Rx directly or via an agency within the last year, will not get ownership unless there was no communication from Capital Rx
• At least 2 years of pharmacy experience
• Recent prior auth experience from a PBM or MCO setting required
• Clear and active Pharmacist license in state they reside
• Graduate from accredited Pharmacy school

Soft Skills Required:

• Strong communication, writing, and organizational skills

Types of Candidates to Submit to Sales Rep: Best Candidate: Prior Authorization Pharmacist with 2+ years from PBM setting Second Best Candidate: Prior Authorization Pharmacist with 2+ years from MCO setting Third Best Candidate: Pharmacist with combined 2 years of experience including 6 months+ of prior auth experience from MCO or PBM setting Day to Day Duties: 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

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.