Clinical Review Pharmacist - Prior Authorization Specialist

SmithRx; Dallas (TX); Presencial; USD 180.521.000 - 186.252.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonuses

Equity

Medical/Dental/Vision

Time off programs

Parental leave

Life & Disability Insurance

401(k)

Descripción de la vacante

SmithRx is suchtly hiring a Clinical Review Pharmacist to enhance clinical offerings and improve outcomes for members and clients. You will review prior authorizations, support clinical programs, and guide providers, pharmacies, and members in a fast-paced environment.

Ideal candidates hold a PharmD or BS Pharm, with an active license and at least two years of practice. The role requires strong communication, adherence to HIPAA, and availability for after-hours work.

Formación

• Doctor of Pharmacy (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.
• 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.

Responsabilidades

• 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

Conocimientos

Pharmacist license

Clinical review

Prior authorization

Documentation

Communication

Regulatory knowledge

After-hours availability

Educación

PharmD or BS Pharm

ACPE-accredited school

Descripción del empleo

SmithRx is suchtly hiring a Clinical Review Pharmacist to enhance clinical offerings and improve outcomes for members and clients. You will review prior authorizations, support clinical programs, and guide providers, pharmacies, and members in a fast-paced environment.

Ideal candidates hold a PharmD or BS Pharm, with an active license and at least two years of practice. The role requires strong communication, adherence to HIPAA, and availability for after-hours work.