Clinical Review Pharmacist: Prior Authorization Specialist

SmithRx; Minneapolis (MN); On-site; USD 63,000 - 65,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

Mental health support

Paid parental leave

Life and disability insurance

401(k)

Job summary

SmithRx's clinical team seeks a Clinical Review Pharmacist to enhance clinical offerings and improve outcomes for members and clients. The role reviews prior authorization requests, supports clinical programs, and advises providers, pharmacies, and members in a fast-paced, collaborative setting.

The ideal candidate holds a PharmD or BS in Pharmacy from an ACPE-accredited school, an active pharmacist license, at least 2 years of practice, and strong communication skills.

Qualifications

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

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 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

Skills

PharmD

Pharmacist license

2+ years experience

Strong communication

Education

ACPE-accredited degree

Tools

Google Workspace

Job description

SmithRx's clinical team seeks a Clinical Review Pharmacist to enhance clinical offerings and improve outcomes for members and clients. The role reviews prior authorization requests, supports clinical programs, and advises providers, pharmacies, and members in a fast-paced, collaborative setting.

The ideal candidate holds a PharmD or BS in Pharmacy from an ACPE-accredited school, an active pharmacist license, at least 2 years of practice, and strong communication skills.