Clinical Review Pharmacist - Prior Authorization & Impact

SmithRx; Louisville (KY); On-site; USD 63,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Mental Health Support

Parental Leave

Life Insurance

Disability Insurance

401(k)

Job summary

SmithRx is seeking a Clinical Review Pharmacist to join our clinical team and enhance outcomes for members and clients. You will review prior authorizations, support clinical programs, and provide guidance to providers, pharmacies, and members in a fast-paced, collaborative setting.

Ideal candidates hold a PharmD or BS Pharm, active license, and 2+ years of pharmacy practice, with strong communication skills and a willingness to work after hours as needed.

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy (B.S. Pharm) from an 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

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
• Accurately document clinical decisions and maintain thorough records per URAC/NCQA utilization review standards
• Provide clear, empathetic support to members, prescribers, and pharmacies
• Stay current with clinical prescribing guidelines, internal policies, and regulatory changes
• Follow HIPAA guidelines to protect patient privacy and data security
• Identify and report potential fraud, waste, and abuse
• Support training and development of team members
• Assist leadership with special projects and process improvements

Skills

Pharmacist Licensure

PharmD or BS Pharm

Pharmacy Practice Experience

Clinical Communication

Regulatory Knowledge

Education

ACPE-accredited PharmD or BS Pharm

Tools

Google Workspace

Job description

SmithRx is seeking a Clinical Review Pharmacist to join our clinical team and enhance outcomes for members and clients. You will review prior authorizations, support clinical programs, and provide guidance to providers, pharmacies, and members in a fast-paced, collaborative setting.

Ideal candidates hold a PharmD or BS Pharm, active license, and 2+ years of pharmacy practice, with strong communication skills and a willingness to work after hours as needed.