Capital Rx

Pharmacist

• 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

Utilization Management Pharmacist – Temp, Temp-to-hire

Data Engineer

• Thoroughly understand all Underwriting and Rebate Administration data sources, fields, and relationships, including historical claims, Medi-Span tables, NCPDP tables, and Capital Rx’s Book of Business data to interpret trends, identify patterns, and conduct complex data analyses in support of Underwriting, Rebate Administration, and Sales business goals
• Investigate new data sources for the purpose of building & maintaining data pipelines to clean, transform, and aggregate disparate data
• Use agile software development to create, maintain, and improve back-end systems for data extracts, pricing processes, and analytic tools to advance the department’s technical capabilities
• Model front-end views and back-end data sources to draw a comprehensive picture of the user experience and analytic pipelines throughout the system and to enable powerful data analysis
• Troubleshoot and customize infrastructure code in SQL, R, and Python to diagnose and solve data or process issues
• Work closely with our Underwriting and Clinical teams to help build complex algorithms that provide useful insights into our data
• Assist in the analysis and development of new models and front-end tools that can be used to make predictions and answer questions for financial modeling & reporting
• Collaborate with various teams across the company on data sources and analytic methodology in support of Underwriting, Rebate Administration, and company objectives
• Provide standard and ad-hoc analytics to support the Underwriting and Rebate Administration teams for the successful completion of bid opportunities and rebate payment management

Underwriting Data Engineer

Analyst

• The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx – JUDI Health and its various partners, including employers, providers, and other TPAs.
• This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims.
• Develop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data.
• Proactively monitor system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy.
• Analyze data trends to identify potential issues or areas for improvement.

Data Exchange Analyst, Medical, Dental & Vision

IT Support

• Research end user issues independently, when needed, and document/develop a solution per company standards
• Develop additional MDM automation to facilitate user onboarding
• Identify MDM related company needs and create, configure, test and deploy management of user systems via MDM Software.
• Collaborate with internal partner teams to identify compliance, best practice, or other IT related policy needs within the cross functional existing processes and workflows; identify and present enhancements and deploy solutions to the business.
• Responsible for all onboarding and offboarding related IT activities, including system-wide access, purchasing and retrieving of equipment, upgrades, asset tagging, etc.
• Create Exchange rules to address spam/phishing emails as needed.
• Collaborate with the IT Engineering team to drive systemic improvements to email filtering system.
• Promptly respond to user requests via ticketing system/phone calls/IM
• Assist users with access/system issues
• Write and update documentation for user reference
• Help build and establish procedures for newly established team
• Participate in a Help Desk OnCall schedule (tentatively will be 1 week/month, with potential higher volume at onset as the team grows).
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

IT Help Desk Technician

Operations

• Lead administrative and operational tasks to support the implementation and operations of clinical programs
• Support clinical programs business development needs
• Validate program identification and claim files
• Generate data outputs and analyze large data sets
• Manage large scale projects to support business needs
• Maintain drug lists to support operations of clinical programs
• Ensure customer satisfaction
• Uphold general business needs and operations as required.

Clinical Programs Specialist – Operations

Account Executive

• Provide oversight of commercial clients within the health system, employer, labor/union and public verticals for large/jumbo accounts (approximately >15,000+ lives, subject to fluctuate due to the needs of the business)
• Serve as the relationship liaison on assigned book of business, incorporating internal support where and when needed to the foster relationship with influencers and decision makers at the plan
• Develop relationship strategy plans, with support of clinical account manager and operations manager
• Support member and client satisfaction execution and net promoter score goals
• Provide deep and approachable trend management recommendations with support of reporting
• Maintain thorough knowledge of contractual obligations assigned book of business, including financials, performance guarantees, terms, and regulatory/compliance
• Lead client renewal process, including contract management
• Lead ownership of performance guarantee reporting and maintenance
• Lead regulatory and compliance components
• Interpret current pharmacy and healthcare trends, and meet with clients to provide proactive recommendations for plan management; find ways of adding value to the client curating offerings tailored to the client’s specific needs
• Identify and contribute to process improvement efforts across Capital Rx
• Assemble internal resources to overcomes challenges
• Anticipates customer needs and proactively identifies new opportunities within assigned accounts
• Comprehensive knowledge of our business, including products and services. Strong ability to field questions from the client side, answer them and answer them correctly
• Review and advise on JUDI product roadmap to ensure current priorities and milestones will meet the client expectation
• Other duties as assigned
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Account Executive, PBM

Program Manager

• Coordinate the day-to-day operations and activities of the Government Programs Operations team
• Manage the shared Outlook mailbox with timely responses
• Lead pharmacy outreach initiatives related to CMS disputes
• Validate system enhancements and provide recommendations
• Design and maintain structured documentation frameworks
• Oversee daily PDE reconciliation activities
• Manage and resolve escalations from claims monitoring activities
• Support strategic Government Programs Operations initiatives

Government Program Operations Specialist

Client Services Representative

• Provide oversight and direction to the broader Account Management team with a focus on client satisfaction, trend management, client growth & retention, and regulatory compliance to meet client specific objectives, client priorities and service model deliverables
• Lead and develop the client relationship strategy and the strategic business planning process across the clients in your portfolio while incorporating other internal staff where and when needed to build and foster relationships with influencers and decision makers
• Maintain thorough knowledge and tracking of contractual obligations on assigned book of business, including financials, performance guarantees, terms, and reporting/compliance
• Manage and facilitate the Account renewal and contracting process with a focus on client retention and the client financial/PNL management
• Serve as the relationship lead on assigned book of business, incorporating other internal staff where and when needed to the relationship; build and foster relationships with influencers and decision makers at the client
• Anticipates customer needs and proactively identifies new opportunities within assigned accounts
• Develop and maintain comprehensive knowledge of our business, including products and services to field questions from the client side and to answer timely & accurately
• Collaborate with internal teams to customize offerings and solutions, aligning with Health Plan/TPA Account needs and market demands - assemble internal resources to overcome challenges
• Analyze and interpret current pharmacy and healthcare trends, competitor activities, and industry regulations to inform strategic decisions, provide proactive recommendations for plan management and enhance the company's positioning within the PBA Services segment
• Lead, coach and support the Account Team on the effective positioning of the Capital Rx value proposition, our suite of Capital Rx Products and Solutions and JUDI capabilities available to our PBA clients
• Partner with our Business Development & Underwriting Teams to support our PBA Account level growth and retention efforts by providing Capital Rx sales support and market differentiator positioning, including RFP support, Broker/Consultant engagement and Best & Final support for prospective, existing and new and client business development needs
• Provide ongoing direction, coordination and coaching to the broader Account Team to align the Account Team understanding of the assigned client(s) business lines, strategies, key stakeholders & decision makers and priorities
• Serve as the content expert for Health Plan/TPA clients & opportunities
• Identify and help contribute to process improvement efforts
• Be accountable & own the client end-to-end, inclusive of service model deliverables, contractual negotiations, client escalations and PNL management.
• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Account Executive, PBA Client Services

Account Manager

• Partner with clinical account manager (CAM) and account executive (AE) to manage clients through the entire lifecycle from implementation through go-live and renewal on a designated book of business
• Support implementation as a critical member of the client management teams with all day-to-day client requirements
• Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, override requests, demos and new implementations
• Analyze incoming client requests and work with internal and external teams to complete required plan documentation
• Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
• Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
• Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
• Travel requirements not to exceed 25%
• Handle and resolve sponsor and member issues, escalating as needed
• Research and respond to claims processing and system configuration inquiries
• Coordinate integration of other data inputs into client management processes
• Collaborate cross functionally to support general client operations, as required
• Responsible for relationship management and contribution to successful NPS and Account Management Survey results, along with retention support
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Account Manager, PBA

Learning and Development

• Serve as the primary L&D partner for Technology leaders and community; establish an intake rhythm and learning priorities aligned to delivery goals.
• Conduct structured needs assessments to identify root causes behind development needs and recommend the right mix of solutions.
• Build trusted partnerships and drive adoption through clear communication, stakeholder alignment, and shared accountability for outcomes.
• Design and deliver enablement that strengthens core concepts and shared language.
• Create reusable toolkits, job aids, and bite-sized learning assets that support on-the-job application.
• Partner with technology leaders to embed reinforcement into operating cadences.

Learning & Development Lead – Technology

Backend Engineer

• Lead the development and deployment of cutting-edge solutions from design to production.
• Collaborate with product managers and cross-functional teams to refine and implement requirements, ensuring seamless integration and user experience.
• Engage with major clients and cross-functional teams to architect innovative solutions and enhance product functionality.
• Establish and maintain consistent, enterprise-grade APIs across services, ensuring interoperability and scalability while employing best practices for interactions with both partner and internal systems.
• Build robust backend applications in Python on AWS Lambda, API Gateway, SMS, ECS, and other cloud technologies.
• Implement backend code in a serverless, cloud-native environment (Flask/AWS Lambda/ECS).
• Design and implement scalable systems capable of handling high-volume transactions, ensuring robustness and reliability.
• Ensure security best practices are followed in all aspects of development and deployment.
• Conduct code reviews to maintain high code quality and standards.
• Demonstrate technical leadership, driving timely execution and high-quality software delivery.
• Make informed architectural decisions through careful evaluation and leveraging prior experience.
• Self-manage tasks, collaborate effectively with both internal and external teams, and drive projects to successful completion.
• Represent the software development team’s products to stakeholders, providing technical insights and solutions.

Senior Backend Developer – Integrations

Scrum Master

• Facilitate Scrum events and coach teams to self-organize and continuously improve.
• Design and lead retrospectives tailored to team needs.
• Assess team Agile maturity and adjust coaching approach to match strengths and weaknesses.
• Guide teams in applying lean and agile principles to improve delivery.
• Support multiple interdependent teams in effectively working together in concert.
• Foster collaboration between Scrum Teams and stakeholders.
• Mediate conflicts and support team dynamics to ensure a healthy team environment.
• Support onboarding and agile adoption for new team members and teams.
• Identify and remove impediments to team progress.
• Leverage empirical data to drive continuous improvement.
• Prepare and present sprint reports including velocity, capacity, and predictability metrics.
• Build and maintain workflows and automation to enhance team and department efficiency.
• Collaborate with product teams on backlog management, coaching on prioritization best practices.
• Assist in roadmap development and release forecasting using agile metrics.
• Promote best practices in lean, iterative software delivery.
• Develop working knowledge of our products to provide targeted coaching, help bridge gaps between teams working on related features, and help provide knowledge and context to others.
• Share discussion topics and tactics to improve the effectiveness of the overall Agile team.
• Help more junior Scrum Masters on their own professional journey through mentoring and less formal guidance.
• Coordinate with other Scrum Masters and Project Managers on larger projects or implementations.
• Tracks quarterly goals for team(s).

Senior Scrum Master

Project Manager

• Collaborate with key stakeholders to develop and maintain new and existing drug cost containment programs for all lines of business (Commercial, Exchange, Medicare, and Medicaid).
• Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
• Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, and other documentation.
• Implement quality control processes to ensure program compliance with established standards and guidelines.
• Own relationships with and provide oversight of third-party vendors (including pharmacies) to administer programs.
• Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting.
• Support the go-to-market strategy of savings product offerings including pricing, marketing, and implementation.
• Evaluate evolving industry and market landscape and analyze prescription claims data to identify opportunities for improving existing products.

Senior Project Manager, Pharmacy Value Programs

• Collaborate with key stakeholders to develop and maintain new and existing market access programs for all relevant lines of business.
• Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
• Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, rules sets, and other documentation as relevant and required.
• Implement quality control processes to ensure program compliance with established standards and guidelines.
• Own relationship with and provide oversight of third-party vendors and/or partners to administer programs with emphasis on member experience and value capture for clients.
• Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting.
• Support the go-to-market strategy of program offerings including pricing, marketing, and implementation.

Senior Project Manager, Market Access Programs

• Collect data on available prices to end users for pharmaceuticals across distribution and reimbursement channels, including traditional insurance reimbursement, direct-to-patient, and direct-to-employer models
• Use available reporting and analytics tools (and collaborate with our dedicated Analytics team) to compare available market pricing to Judi Health’s contracted pricing for pharmaceuticals; facilitate executive understanding of pricing variability
• Identify and investigate opportunities for pricing improvement, working with other teams and departments to scope initiatives aimed at achieving more favorable pricing for client plans and their members
• Design and implement pricing variability data reporting for consumption by users across teams and levels that can be integrated into workflows of relevant teams (for example, audit, network management, etc.)
• Use industry news and direction from our Legal team to facilitate understanding among key stakeholders of health plan sponsor fiduciary duty and our strategies to fulfill our responsibilities as dedicated administrators