Clinical Review Pharmacist: Prior Authorization & Appeals

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

Job summary

SmithRx is seeking a Clinical Review Pharmacist to enhance clinical offerings and outcomes for members and clients. The role operates in a fast-paced, collaborative environment, reviewing prior authorizations and supports clinical programs while guiding providers, pharmacies, and members. The position requires a PharmD or B.S.

in Pharmacy, an active pharmacist license, and at least two years of practice. Flexibility to work after hours and weekends is expected, with emphasis on accurate

Qualifications

• PharmD or Bachelor of Science in Pharmacy from ACPE-accredited school.
• Active, unrestricted pharmacist license in home state.
• 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.
• Familiarity with drug information, clinical guidelines, formulary design, and utilization management.
• Flexibility to work after hours, weekends, and holidays.

Responsibilities

• 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 business.
• Document clinical decisions and maintain records per URAC/NCQA utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries.
• Stay current with prescribing guidelines and regulatory changes and apply them to daily responsibilities.
• Follow HIPAA guidelines to protect patient privacy and data security.
• Identify and report potential fraud, waste, and abuse (FWA).
• Support training and development of team members; assist leadership with special projects.

Skills

Communication

Writing

Organization

Multitasking

Education

PharmD or B.S. Pharm (ACPE accredited)

Tools

Google Workspace

Job description

SmithRx is seeking a Clinical Review Pharmacist to enhance clinical offerings and outcomes for members and clients. The role operates in a fast-paced, collaborative environment, reviewing prior authorizations and supports clinical programs while guiding providers, pharmacies, and members. The position requires a PharmD or B.S.

in Pharmacy, an active pharmacist license, and at least two years of practice. Flexibility to work after hours and weekends is expected, with emphasis on accurate