Clinical Review Pharmacist - Prior Auth & Appeals Expert

SmithRx; Anderson (SC); On-site; USD 63,000 - 65,000; Full time

Job summary

SmithRx’s Clinical Review Pharmacist collaborates with a fast-paced team to review prior authorization requests and clinical programs, guiding providers, pharmacies, and members with evidence-based decisions and patient-centered support.

The role requires PharmD or B.S. in Pharmacy, an active state license, and at least two years of practice, with strong communication and regulatory knowledge to ensure compliant, high-quality care.

Qualifications

• PharmD or B.S. 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 environment.
• Understanding of drug information, guidelines, formulary design, utilization management.
• Flexible and adaptable to changes; after hours/weekends as needed.

Responsibilities

• Review and decide on prior authorizations and appeals using guidelines.
• Ensure compliance with federal/state regulations and URAC/NCQA standards.
• Document clinical decisions and maintain records accurately.
• Provide empathetic support to members, prescribers, and pharmacies.
• Stay current with prescribing guidelines and internal policies.

Skills

Pharmacist license in state

2+ years pharmacy practice

Clinical decision making

Communication skills

Documentation skills

HIPAA compliance

Regulatory knowledge

Education

PharmD or B.S. in Pharmacy

Tools

Google Workspace

Job description

SmithRx’s Clinical Review Pharmacist collaborates with a fast-paced team to review prior authorization requests and clinical programs, guiding providers, pharmacies, and members with evidence-based decisions and patient-centered support.

The role requires PharmD or B.S. in Pharmacy, an active state license, and at least two years of practice, with strong communication and regulatory knowledge to ensure compliant, high-quality care.