Clinical Review Pharmacist - Prior Authorization Specialist

SmithRx; Phoenix (AZ); On-site; USD 87,000 - 91,000; Full time

Benefits offered by this job

Bonuses

401(k)

Medical, dental, vision

Mental health support

Paid parental leave

Life and disability insurance

Job summary

SmithRx in the United States is seeking a Clinical Review Pharmacist to join its growing clinical team in Phoenix. The role combines clinical expertise with service excellence to review prior authorization requests, support clinical programs, and provide guidance to providers, pharmacies, and members.

The ideal candidate holds a PharmD or BS in Pharmacy, is licensed, and has at least two years of experience; familiarity with URAC/NCQA utilization review, PBM awareness, and strong communication

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

Communication skills

Writing

Organizational skills

Multitasking

Clinical knowledge

Adaptability

After-hours availability

Education

PharmD or BS Pharmacy (ACPE accredited)

Tools

Google Workspace

Job description

SmithRx in the United States is seeking a Clinical Review Pharmacist to join its growing clinical team in Phoenix. The role combines clinical expertise with service excellence to review prior authorization requests, support clinical programs, and provide guidance to providers, pharmacies, and members.

The ideal candidate holds a PharmD or BS in Pharmacy, is licensed, and has at least two years of experience; familiarity with URAC/NCQA utilization review, PBM awareness, and strong communication