Job description

Clinical Account Executive 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 Clinical Account Executive. The Clinical Account Executive (CAE) serves as the primary clinical lead and expert for assigned client accounts, providing strategic guidance, clinical oversight, and Population Health management in alignment with EmpiRx Health’s value-based model. This role is responsible for ensuring clinical program performance, delivering actionable insights to clients, and proactively managing clinical savings and cost trends. CAEs work cross-functionally with internal teams and external stakeholders to support clients' pharmacy benefit goals, ensure clinical guarantees are met, and enhance the member experience. Key Responsibilities: 1. Clinical Lead & Expert • Serve as the clinical expert for assigned client accounts, providing clinical guidance on benefit design, program performance, and population trends. • Maintain the client playbook and have full knowledge of each client’s benefit design, formulary, and customizations. • Participate in quarterly and annual client performance reviews and regular meetings to present clinical outcomes, cost trends, and strategic recommendations. • Deliver a high-touch service experience consistent with EmpiRx Health’s white-glove client model. 2. Population Health Management • Demonstrate proficiency in EmpiRx Health’s Population Health Model, including use of Johns Hopkins ACG risk stratification tools. • Utilize and present data from the Population Health Dashboard to help clients understand member health trends and risk assessments. 3. Clinical Savings Oversight • Track and manage PMPM cost trends and clinical risk for assigned clients. • Monitor the drug pipeline for new-to-market drugs, first-time generics, and biosimilars to identify proactive clinical strategies. • Provide support for clinical savings reconciliation process on as needed bases during high-volume period. 4. New Client Implementation • Support new client onboarding by recommending appropriate clinical programs, formularies, and benefit setups. • Review incumbent PBM documents (e.g., SPDs) and consult on drug coverage and plan structure. • Ensure smooth transition of care (TOC) for newly implemented clients, including appropriate override placement and member/prescriber communication. 5. Tools & Reporting • Generate ad-hoc clinical reports, drug lists, and custom communications tailored to client needs. • Leverage external clinical resources (e.g., IPD, UpToDate, MediSpan, Policy Reporter) to support clinical decision-making and stay current with drug pipeline developments. 6. Cross-Functional & Stakeholder Collaboration • Collaborate with Care Management, Prior Authorization, Plan Build, Client Experience, Formulary, Underwriting, Marketing, and Analytics teams. • Serve as the clinical liaison for external partners and vendors engaged by assigned clients. • Respond promptly to inquiries from internal and external stakeholders, ensuring all clinical aspects are addressed accurately and efficiently. • Assist with special projects and initiatives aimed at enhancing and improving clinical operations and workflows. • Cross-trained in Population Health Executive functions to support team members during peak demand, ensuring seamless operations and maintaining productivity across teams. Education: PharmD Required Qualifications & Experience: • 5 years of experience in pharmacy benefit management, clinical account management, or healthcare consulting. • Strong background in clinical program development and drug utilization review. • Analyzed client prescription data. • Provided ongoing client support and promoted clinical products. • Collaborated cross-functionally with product development and customer service teams. • Clinical expertise in pharmacy benefit design and population health management. Skills: • Strong written and verbal communication skills with the ability to present clinical data and strategies to clients. • High attention to detail, organizational skills, and ability to manage multiple priorities. • Proficiency in Microsoft Office Suite; familiarity with Salesforce, DOMO, RXCurve, and other PBM platforms. • Flexible and adaptable with focus on improving organizational effectiveness. • Client-focused, solutions-oriented mindset with the ability to work cross-functionally and independently. Licensure/ Certifications: • Active Pharmacist License in good standing (Required) • Board Certification (e.g., BCPS, BCACP, BCOP) preferred Work Environment: Hybrid, Montvale, NJ The expected salary range for this New Jersey position is between $125,000 - $155,00. Total earnings may also include various incentive options.   Actual pay will be adjusted based on experience, education, geographic location, and other job-related factors as permitted by law. Subject to program eligibility, this position qualifies for a robust suite of benefits including Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Health Savings Account, and an Employee Assistance Program.) Benefits And Perks Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Student Loan Reimbursement, Health Savings Account, and an Employee Assistance Program. EmpiRx Health is an Equal Opportunity Employer At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together. Note: This job description is a general outline of responsibilities and qualifications for the role. Additional duties may be assigned, and the position may evolve to meet the organization's needs.

Requirements

Must-haves

Clinical Account Executive
Clinical Lead & Expert
Serve as the clinical expert for assigned client accounts, providing clinical guidance on benefit design, program performance, and population trends.
Maintain the client playbook and have full knowledge of each client’s benefit design, formulary, and customizations.
Participate in quarterly and annual client performance reviews and regular meetings to present clinical outcomes, cost trends, and strategic recommendations.
Deliver a high-touch service experience consistent with EmpiRx Health’s white-glove client model.
Population Health Management
Demonstrate proficiency in EmpiRx Health’s Population Health Model, including use of Johns Hopkins ACG risk stratification tools.
Utilize and present data from the Population Health Dashboard to help clients understand member health trends and risk assessments.
Clinical Savings Oversight
Track and manage PMPM cost trends and clinical risk for assigned clients.
Monitor the drug pipeline for new-to-market drugs, first-time generics, and biosimilars to identify proactive clinical strategies.
Provide support for clinical savings reconciliation process on as needed bases during high-volume period.
New Client Implementation
Support new client onboarding by recommending appropriate clinical programs, formularies, and benefit setups.
Review incumbent PBM documents (e.g., SPDs) and consult on drug coverage and plan structure.
Ensure smooth transition of care (TOC) for newly implemented clients, including appropriate override placement and member/prescriber communication.
Tools & Reporting
Generate ad-hoc clinical reports, drug lists, and custom communications tailored to client needs.
Leverage external clinical resources (e.g., IPD, UpToDate, MediSpan, Policy Reporter) to support clinical decision-making and stay current with drug pipeline developments.
Cross-Functional & Stakeholder Collaboration
Collaborate with Care Management, Prior Authorization, Plan Build, Client Experience, Formulary, Underwriting, Marketing, and Analytics teams.
Serve as the clinical liaison for external partners and vendors engaged by assigned clients.

Nice-to-haves

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

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

Platform: adp-workforce-now
Effort: medium

Benefits

Benefits detected in the listing.

Health Insurance

Dental

Vision

401(K)

Pto

Paid Time Off