[Hiring] Clinical Review Pharmacist @SmithRx

Role Description

Joining SmithRx’s clinical team, the Clinical Review Pharmacist plays a key role in enhancing clinical offerings and improving outcomes for our members and clients. Operating in a collaborative and fast-paced environment, this position pairs clinical expertise with service excellence to:

• Review and make timely, evidence-based decisions on prior authorizations and appeals using clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across applicable lines of businesses.
• 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, 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 (FWA).
• Support training and development of new and existing team members as needed.
• Assist leadership with special projects, process improvements, and operational initiatives.

Qualifications

• Doctor of Pharmacy (PharmD.) or Bachelor of Science in Pharmacy (B.S. Pharm) from an ACPE-accredited school of pharmacy.
• Active, unrestricted, pharmacist license in state of residence.
• Minimum of 2 years of pharmacy practice experience.
• Strong communication, writing, and organizational skills.
• Ability to manage multiple priorities in a high-volume, metric-driven environment.
• General understanding of drug information, clinical guidelines, formulary design, and utilization management strategies.
• Flexible and adaptable to changes.
• Availability to work after hours, weekends, and holidays on a rotating or fixed schedule.

Requirements

• One year of prior authorization or utilization management experience (preferred).
• One year experience in managed care or pharmacy benefit management (PBM) (preferred).
• Direct experience conducting prior authorization reviews, clinical appeals, formulary exceptions, step therapy evaluations, and quantity limit reviews (preferred).
• Experience in Google Workspace (Gmail, Docs, Sheets, and Drive) (preferred).

Benefits

• Base Salary: The range listed reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.
• Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity.
• SmithRx offers a variety of benefits to help you live well, including:
• Time off programs
• Medical, dental, vision, mental health support
• Paid parental leave
• Life and disability insurance
• 401(k)
• Individual offers are tailored to your geography, experience, skills, and education.