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Clinical Operations

Senior Clinical Programs Manager

Location: Remote

About Capital Rx

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.

Position Responsibilities:

  • Lead the development and maintenance of existing and new clinical programs across multiple lines of business with emphasis on Medicare and Medicaid Programs including drug utilization review, medication therapy management, drug management program, CMS Star Ratings, adherence, and disease management programs
  • Manage the complete life-cycle of Capital Rx’s suite of clinical programs
  • Own relationships and provide oversight of clinical programs administered by third party vendors
  • Conduct case management of eligible program members and their prescribers
  • Utilize an agile build process to deliver programs built on a modern technology stack
  • Evaluates industry data with clinical programs subject matter expertise to improve existing products and make recommendations for new products with a focus on clinical offerings and value proposition
  • Analyze and interpret prescription claims data to identify opportunities to improve existing programs and develop innovative programs
  • Conduct and publish research that drive outcomes by improving cost effective use of medications
  • Supports quality improvement programs/projects as required
  • Support RFI and RFP submissions
  • Support general business needs and operations, as required


Required Qualifications:

  • PharmD required
  • Maintain an active, unrestricted pharmacy license in the state of residence
  • Completion of a PGY1 Clinical Pharmacy Residency Program, Managed Care Residency or Fellowship, preferred
  • Medicare Part D experience, required
  • 4+ years of applicable experience in a health plan, or PBM, required with 2+ years management experience, preferred
  • 2+ years management experience in Medicare required Medication Therapy Management
  • Experience working with HEDIS, Stars and PQA pharmacy quality measures
  • Experience in managing Medicare Drug Management Program (Opioid Overutilization)
  • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel
  • Experience working with large datasets preferred
  • Ability to balance multiple complex projects simultaneously
  • Ability to travel
  • Exceptional written, verbal, and presentation skills


Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.