Clinical Review Pharmacist: Prior Authorization & Appeals

SmithRx; Houston (TX); Sur place; USD 63 000 - 66 000; Plein temps

Avantages offerts par ce poste

Bonuses

401(k)

Medical insurance

Paid parental leave

Life and disability insurance

Mental health support

Résumé du poste

SmithRx is a rapidly growing Health-Tech company in the U.S. seeking a Clinical Review Pharmacist to review prior authorizations, support clinical programs, and guide providers, pharmacies, and members.

The role emphasizes evidence-based decisions, documentation, and HIPAA-compliant processes, in a fast-paced collaborative team. Candidates should have PharmD or BS Pharm, an active license, and 2+ years of pharmacy practice, with strong communication and multitasking abilities to manage

Qualifications

• Doctor of Pharmacy (PharmD.) or Bachelor of Science in Pharmacy 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

Responsabilités

• 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

Connaissances

Communication skills

Writing skills

Organizational skills

Multitasking

Healthcare knowledge

Regulatory awareness

Formation

Doctor of Pharmacy (PharmD.) or Bachelor of Science in Pharmacy

Outils

Google Workspace

Description du poste

SmithRx is a rapidly growing Health-Tech company in the U.S. seeking a Clinical Review Pharmacist to review prior authorizations, support clinical programs, and guide providers, pharmacies, and members.

The role emphasizes evidence-based decisions, documentation, and HIPAA-compliant processes, in a fast-paced collaborative team. Candidates should have PharmD or BS Pharm, an active license, and 2+ years of pharmacy practice, with strong communication and multitasking abilities to manage