Population Health Clinical Executive

EmpiRx Health, LLC•Montvale, NJ

14h•$102,997 - $147,139•Hybrid

About The Position

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, which has been on an explosive growth trajectory in recent years. EmpiRx Health is in unprecedented growth, and we're seeking a highly skilled and experienced Population Health Clinical Executive. The Population Health Clinical Executive plays a key role within the Care Management department, responsible for the timely and accurate execution of clinical interventions aligned with EmpiRx Health’s value-based model. This role focuses on monitoring and managing RXCurve tickets, review of high-cost cases, executing clinically appropriate interventions, documenting savings opportunities, and supporting data tracking and reporting efforts. The Population Health Clinical Executive collaborates closely with the Population Health Clinical Manager, Clinical Account Executives (CAEs), Prior Authorization, Clinical Pharmacy Technicians (CPTs), Analytics, and other internal stakeholders to drive clinical outcomes and operational excellence.

Requirements

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
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.
Active Pharmacist License in good standing (Required)

Nice To Haves

Board Certification (e.g., BCPS, BCACP, BCOP) preferred

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.