[Hiring] Senior Clinical Review Operations Pharmacist @SmithRx

Role Description

SmithRx is looking for a motivated Senior Clinical Review Operations Pharmacist to serve as a clinical subject matter expert and key operational driver within our Prior Authorization team. This individual contributor role is pivotal in maintaining high-quality clinical reviews, ensuring adherence to turnaround times, and delivering exceptional member experiences. Your primary focus will be building tools to support prior authorization evaluations, driving process improvements, mentoring peer pharmacists on clinical protocols, and serving as a key cross-functional innovator to scale our clinical operations.

What you will do:

• Process & Technology Optimization: Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency.
• Clinical Mentorship & Quality Assurance: Serve as a clinical peer lead, providing guidance, coaching, and onboarding support to fellow pharmacists to foster clinical consistency and quality.
• Complex Escalations: Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals.
• Cross-Functional Collaboration: Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances.
• Clinical Policy & P&T Committee Support: Collaborate with clinical leadership and the Pharmacy and Therapeutics (P&T) Committee to help develop, refine, and review clinical criteria for medications requiring prior authorization.
• Performance & SLAs: Consistently meet or exceed individual target KPIs and turn-around-time (TAT) SLAs to maintain seamless operating standards.
• Change Champion: Drive adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team.

Qualifications

• 5+ years of health plan or Pharmacy Benefit Manager (PBM) experience, specifically involved in prior authorization review and clinical operations.
• Demonstrated expertise as a clinical subject matter expert with a track record of driving process improvements or technology-driven efficiencies.
• Active Pharmacist License (unrestricted) required.
• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
• Strong proficiency with Mac, MS Office, and G-Suite platforms.
• High degree of empathy with excellent active listening and communication skills to clearly convey complex clinical information to members, providers, and internal stakeholders.
• Proven self-starter with superior multitasking, time management, and problem-solving abilities in a fast-paced environment.
• Deep understanding of drug product/dose calculations, claim adjudication rules, and general pharmacy dispensing processes.
• Adaptability to evolving clinical guidelines, changing protocols, and new operational technology.

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary Paid Time Off
• Paid Company Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities

Compensation & Benefits

The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience. 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 and 401(k). Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process.