Remote Clinical Review Pharmacist: Prior Authorization Pro

SmithRx; Northern (KY); Hybrid; USD 63,000 - 66,000; Full time

Benefits offered by this job

Time off programs

Medical insurance

Dental insurance

Vision insurance

Mental health support

Paid parental leave

Life insurance

Disability insurance

401(k)

Job summary

SmithRx, a US-based health-tech company, seeks a Clinical Review Pharmacist to review prior authorizations, support clinical programs, and guide providers, pharmacies, and members in a fast-paced setting. Requires PharmD or BS in Pharmacy, active state license, 2+ years of practice, and strong communication.

Remote US work with competitive base pay and comprehensive benefits. Join a mission-driven team focused on improving patient outcomes through evidence-based reviews and collaborative

Qualifications

• 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 written and verbal communication skills.

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 records per URAC/NCQA utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries.
• Stay current with 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 team members and assist leadership with projects.
• Assist leadership with special projects and process improvements.

Skills

Communication

Writing

Organization

Prioritization

Pharmacy knowledge

Regulatory awareness

Adaptability

After-hours availability

Education

PharmD or BS in Pharmacy

Tools

Google Workspace

Job description

SmithRx, a US-based health-tech company, seeks a Clinical Review Pharmacist to review prior authorizations, support clinical programs, and guide providers, pharmacies, and members in a fast-paced setting. Requires PharmD or BS in Pharmacy, active state license, 2+ years of practice, and strong communication.

Remote US work with competitive base pay and comprehensive benefits. Join a mission-driven team focused on improving patient outcomes through evidence-based reviews and collaborative