Clinical Review Pharmacist (6-month, full-time contract)

SmithRx; Orlando (FL); On-site; USD 87,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision

Mental health support

Paid parental leave

Life and disability insurance

401(k)

Job summary

SmithRx, a fast-growing Health-Tech leader in PBM solutions, seeks a Clinical Review Pharmacist to review prior authorizations and guide clinical programs. You will support providers, pharmacies, and members in a fast-paced team while upholding privacy and regulatory standards.

Join a mission-driven culture with competitive pay based on geography and qualifications. Zone-based pay ranges reflect whether you work in zones A, B, or C, with comprehensive medical, dental, vision, mental health

Qualifications

• Pharmacist with PharmD or BS in Pharmacy from ACPE-accredited school.
• 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.
• Understand drug information, clinical guidelines, formulary design and utilization management.
• Flexible and adaptable to changes.
• Available to work after hours, weekends, and holidays on a rotating or fixed schedule.

Responsibilities

• Review and decide on prior authorizations and appeals using guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across lines of business.
• Document clinical decisions and maintain records per URAC/NCQA utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies.
• Stay current with prescribing guidelines, policies, and regulatory changes.
• Follow internal procedures, HIPAA guidelines to protect privacy and data security.
• Identify and report potential fraud, waste and abuse (FWA).
• Support training and development of team members as needed.
• Assist leadership with special projects and process improvements.

Skills

Communication skills

Organizational skills

Multitasking

Education

PharmD or B.S. in Pharmacy

Tools

Google Workspace

Job description

Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:

• Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
• Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
• Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.

Job Summary:

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 prior authorization requests, support clinical programs, and offer guidance to providers, pharmacies, and members.

What you will do:

• 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

Minimum 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

Preferred Qualifications:

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

Zone A includes the following locations:San Francisco Bay Area - CaliforniaMetro New York City - Connecticut, New Jersey, New York and Pennsylvania

Zone A Pay Range: $64 USD - $66 USD

Zone B includes the following locations:California - outside of San Francisco Bay AreaMetro Denver / Boulder - ColoradoMetro District of Columbia - District of Columbia, Maryland, Virginia and West VirginiaMetro Boston / Cambridge - Massachusetts and New HampshireMetro Austin - TexasMetro Seattle - Washington

Zone B Pay Range: $63 USD - $65 USD

Zone C includes all other locations not listed above, including:Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Wisconsin, WyomingNon metro Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Virginia, Washington, and West Virginia

Zone C Pay Range: $63 USD - $65 USD

Compensation & Benefits

• Base Salary: 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.
• 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 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. In the meantime, feel free to explore our comprehensive benefits here.