Member Care Advocate
21 days ago
Montvale
Job Description Member Care Advocate 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 experiencing a period of accelerated growth and platform expansion. We are seeking a Member Care Advocate (MCA) to add to our team. The Member Care Advocate (MCA) delivers EmpiRx Health’s high-touch, concierge-level support to members with complex care needs. This role involves proactive case management using the Population Health system to oversee and resolve all member-related issues. The MCA is responsible for managing assigned member cases with exceptional attention to detail, ensuring timely resolution of escalations and consistently delivering best-in-class service. Key Responsibilities: ADVOCACY: • Act as a dedicated advocate for members of assigned clients (serving approximately 30,000 lives), with an emphasis on providing personalized support to flagged members requiring additional attention., • Adhere to established protocols to consistently deliver EmpiRx Health’s best-in-class concierge service experience., • Manage and close assigned cases in the Population Health engine promptly and accurately., • Conduct outreach to members, prescribers, and/or pharmacies in alignment with daily call expectations (approximately 30 calls per day) to meet established KPI targets., • Address and resolve member escalations professionally and courteously, following standard procedures within a 24–48-hour turnaround., • Utilize Salesforce to document, communicate, and track member and client requests with relevant internal teams., • Respond to all email inquiries promptly to ensure timely and effective communication., • Consistently follow defined processes and procedures to maintain superior concierge-level service experience for all members., • Possess a thorough understanding of claims processes and demonstrate the ability to effectively triage and resolve claim-related issues., • Assist members with prior authorization needs by coordinating with providers and pharmacies as needed., • Support organizational initiatives by participating in ad-hoc projects involving member outreach or special assignments., • Collaborate with internal departments to ensure comprehensive resolution of member issues. RELATIONSHIP MANAGEMENT: • Respond to requests from Clinical Account Executives, including making outbound calls to providers and pharmacies., • Handle inquiries and requests from the Client Management team, including outreach to members, providers, and pharmacies., • Partner with external vendors when necessary to resolve complex member concerns., • Certified Pharmacy Technician (MUST BE NATIONALLY CERTIFIED TO BE CONSIDERED), • 2 years of experience working for a PBM, health plan or call center of medication therapy management (MTM) program; or 4 years of experience in a hospital or retail environment, • Experience with Microsoft Office, • Strong customer service orientation and commitment to delivering concierge-level service, • Ability to work in a fast-paced environment, • Excellent written and oral communication skills (Outlook skills preferred), • Excellent time management skills and ability to meet tight deadlines Preferred Qualifications: (not needed if internal) • 4 year college degree Work Environment: On Site in Montvale, NJ The expected salary range for this New Jersey position is between $55,000 and $65,000. 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, Tuition Reimbursement, Health Savings Account, and an Employee Assistance Program. Benefits and Perks Our commitment to diversity is reflected in our family and LGBTQ-friendly benefits, which include: • Comprehensive medical, prescription, vision, dental, life, and disability insurance, with coverage for domestic partnerships., • A 401K program to secure your financial future., • Parental leave for childbirth and adoption., • Student loan reimbursement., • Additional perks include flexible PTO, hybrid and remote work arrangements, online wellness resources and counseling access, and bi-weekly "take a break" sessions. 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.