Remote Clinical Review Pharmacist

SmithRx; United States; Remote; USD 87,000 - 91,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Mental health support

Paid parental leave

Life and disability insurance

401(k)

Job summary

SmithRx, a US remote health-tech company, is seeking a Clinical Review Pharmacist to review prior authorization requests and provide guidance to providers, pharmacies, and members. You will work in a fast-paced, collaborative clinical team, applying evidence-based guidelines to improve outcomes and ensure compliant decisions.

The role emphasizes accuracy, patient-centered service, and staying current with regulatory changes. Remote work is offered with nationwide scope in the United States.

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.
• Availability to work after hours, weekends, and holidays on a rotating or fixed schedule.

Responsibilities

• Review and make timely, evidence-based decisions on prior authorization requests 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 records per URAC/NCQA utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries.
• 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 (FWA).
• Support training and development of new and existing team members.
• Assist leadership with special projects and process improvements.

Skills

Communication skills

Writing skills

Organizational skills

Multitasking

After-hours availability

Education

PharmD or B.S. Pharm

Tools

Google Workspace

Job description

SmithRx, a US remote health-tech company, is seeking a Clinical Review Pharmacist to review prior authorization requests and provide guidance to providers, pharmacies, and members. You will work in a fast-paced, collaborative clinical team, applying evidence-based guidelines to improve outcomes and ensure compliant decisions.

The role emphasizes accuracy, patient-centered service, and staying current with regulatory changes. Remote work is offered with nationwide scope in the United States.