Clinical Programs Specialist

4 hours, 44 minutes ago
Full-time
Junior
Project and Program Management
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Support daily administration of clinical programs involving vendor partners.
  • Maintain workflows, SOPs, job aids, process maps, reference materials, and other operational documentation.
  • Monitor shared inboxes, work queues, recurring deliverables, escalations, and pending activities.
  • Document program activities, decisions, issues, interventions, and follow-up actions.
  • Maintain clinical program resources, including drug lists and scheduled or ad hoc updates.
  • Monitor vendor service-level commitments, reporting schedules, invoices, and required deliverables.
  • Coordinate inquiries, escalations, implementations, claims monitoring, member communication proofs, and issue resolution.
  • Collaborate with internal and external stakeholders to support client experience and continuity of member care.
  • Identify workflow gaps and operational risks, escalate recommendations, and support process updates.
  • Maintain compliance with HIPAA, applicable regulations, internal SOPs, and company policies.

Requirements

  • Active, unrestricted pharmacy technician license, LPN, CMA, or equivalent healthcare administration, public health, or health sciences license.
  • 1+ years of experience in a health plan, managed care, PBM, TPA, case management, utilization management, quality, population health, clinical operations, or related healthcare environment.
  • Experience supporting clinical programs, operational workflows, implementations, or stakeholder coordination.
  • Ability to manage multiple complex projects with minimal direction and meet deadlines.
  • Strong oral, written, interpersonal, problem-solving, facilitation, and organizational skills.
  • Secure, private home workspace with a closed door and minimal disruptive noise during work hours.
  • Internet connectivity meeting company remote-work standards.
  • Experience with clinical vendors, service-level tracking, project implementations, medical or pharmacy claims, or business analysis preferred.
  • Knowledge of HEDIS, Medicare Stars, CAHPS, CMS, NCQA, or health plan quality programs preferred.
  • Experience with Confluence, Jira, Tableau, or Salesforce preferred; bilingual Spanish is a plus.

Benefits

  • Remote US position.
  • Base salary range of $65,000–$75,000 USD.
  • Equal employment opportunity and anti-discrimination protections.

Interested in this position?

Apply directly on the company website

Apply Now

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