Department

Job Title

Capital Rx is redefining the way prescriptions are priced and administered in the U.S. Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes. The company's commitment to innovation, technology, and service is why Capital Rx is the fastest-growing pharmacy benefit manager in America.

Finance

Manager, Financial Performance – Pharmacy Network Pricing

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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:

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• Lead, develop, mentor and grow the team responsible for pharmacy reconciliations, pharmacy network pricing quality control/surveillance, and pharmacy drug list management.
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• Lead continued development, maintenance and monitoring of pharmacy network pricing and reconciliation models and the Company’s pharmacy reporting infrastructure
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• Coordinate with cross-functional teams to ensure network pricing is accurately produced and maintained
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• Lead function responsible for identifying potential pharmacy network pricing variances and drive timely resolution of variances
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• Utilize SQL queries and/or Python to manage structured and unstructured data
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• Analyze benefit and network pricing testing files to ensure claims are accurately priced
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• Collaborate with other business functions (network, provider relations, clinical, underwriting, finance) to design, refine, and maintain internal pricing, modeling, and reporting SOPs
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• Develop KPI metrics and reporting to track progress on efficiency gains, issue resolution and successful mitigation of financial exposure
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• Support pharmacy appeals and ad-hoc requests related to drug pricing
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• Support the analysis and development of complex pricing models
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• Support general business needs and ad-hoc analysis, as required
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Required Qualifications:

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• Undergraduate bachelor’s degree, with record of strong academic performance in Accounting, Finance, Actuarial Science, Statistics, Economics, Mathematics, or Business Administration
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• 5+ years of proven experience in financial analysis, actuarial services, accounting, pricing and underwriting, network pricing, or pricing operations
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• Prior PBM experience highly preferred
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• The ideal candidate will understand pharmacy pricing dynamics and have experience evaluating the financial performance of pharmacy plans with a focus on accuracy and attention to detail
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• Experience working with structured and unstructured data
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• Highly analytical; demonstratable knowledge of SQL, Excel, or other data visualization tools (Python or R experience preferred though not required)
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• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines and executing on deliverables
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• Strong attention to detail with an intellectual and professional curiosity
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• Ability to balance multiple complex projects simultaneously
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• Exceptional written and verbal communication skills
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• Extremely flexible, highly organized, and able to easily shift priorities
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Base Salary: $100,000 - $130,000

This range represents the low and high end of the anticipated base salary range for the NY - based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.

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.