Senior Clinical Review Operations Pharmacist

SmithRx; Oregon; Ibrido; USD 173.000 - 204.000; Tempo pieno

Vantaggi offerti da questo lavoro

Wellness benefits

401(k) retirement savings

Disability insurance (short and long)

Paid time off

Company holidays

Professional development

Commuter benefits

Parental leave

Employee assistance program (EAP)

Descrizione del lavoro

SmithRx is seeking a Senior Clinical Review Operations Pharmacist to act as a clinical SME and key operator within the Prior Authorization team. This role emphasizes delivering high-quality clinical reviews, meeting turnaround times, and enhancing member experiences.

You will build tools to support prior authorization evaluations, drive process improvements, mentor peers on clinical protocols, and work with cross-functional teams to scale clinical operations.

Competenze

• 5+ years in health plan or PBM, with prior authorization review experience.
• Clinical SME with a track record of driving process improvements or tech-driven efficiencies.
• Active Pharmacist License (unrestricted) required.
• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
• Strong proficiency with Mac, MS Office, and G-Suite platforms.
• Empathy with excellent communication to convey complex clinical information to members and providers.
• Proven self-starter with multitasking and time management in fast-paced environments.
• Deep understanding of drug product/dose calculations and claim adjudication rules.
• Adaptability to evolving clinical guidelines and new operational technology.

Mansioni

• Process & Technology Optimization: Identify operational gaps and champion tech-driven solutions to improve throughput and workflow.
• Clinical Mentorship & Quality Assurance: Provide coaching and onboarding support to fellow pharmacists to ensure clinical consistency and quality.
• Complex Escalations: Serve as senior operational contact for complex clinical cases and appeals.
• Cross-Functional Collaboration: Work with internal teams to troubleshoot eligibility questions and claim design nuances.
• Clinical Policy & P&T Committee Support: Help develop and refine clinical criteria for medications requiring prior authorization.
• Performance & SLAs: Meet or exceed KPIs and TAT SLAs to maintain high standards.
• Change Champion: Drive adoption of new tools and updated protocols across the Clinical Review team.

Conoscenze

Health plan/PBM experience

Clinical subject matter expert

Active Pharmacist License

Drug calculations & claim adjudication

Tech savvy: Mac/MS Office/GSuite

Process improvement

Multitasking & time management

Adaptability to guidelines & new tech

Formazione

Bachelor's degree in Pharmacy or PharmD

Strumenti

Mac OS

MS Office

G-Suite

Descrizione del lavoro

Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country. We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality.

At our core, we are guided by our company values:

• Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.


• Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.


• Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.

Job Summary:

SmithRx is looking for a motivated Senior Clinical Review Operations Pharmacist to serve as a clinical subject matter expert and key operational driver within our Prior Authorization team. This individual contributor role is pivotal in maintaining high-quality clinical reviews, ensuring adherence to turnaround times, and delivering exceptional member experiences. Your primary focus will be building tools to support prior authorization evaluations, driving process improvements, mentoring peer pharmacists on clinical protocols, and serving as a key cross-functional innovator to scale our clinical operations.

What you will do:

• Process & Technology Optimization: Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency.


• Clinical Mentorship & Quality Assurance: Serve as a clinical peer lead, providing guidance, coaching, and onboarding support to fellow pharmacists to foster clinical consistency and quality.


• Complex Escalations: Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals.


• Cross-Functional Collaboration: Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances.


• Clinical Policy & P&T Committee Support: Collaborate with clinical leadership and the Pharmacy and Therapeutics (P&T) Committee to help develop, refine, and review clinical criteria for medications requiring prior authorization.


• Performance & SLAs: Consistently meet or exceed individual target KPIs and turn-around-time (TAT) SLAs to maintain seamless operating standards.


• Change Champion: Drive adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team.

What you will bring to SmithRx:

• 5+ years of health plan or Pharmacy Benefit Manager (PBM) experience, specifically involved in prior authorization review and clinical operations.


• Demonstrated expertise as a clinical subject matter expert with a track record of driving process improvements or technology-driven efficiencies.


• Active Pharmacist License (unrestricted) required.


• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) required.


• Strong proficiency with Mac, MS Office, and G-Suite platforms.


• High degree of empathy with excellent active listening and communication skills to clearly convey complex clinical information to members, providers, and internal stakeholders.


• Proven self-starter with superior multitasking, time management, and problem-solving abilities in a fast-paced environment.


• Deep understanding of drug product/dose calculations, claim adjudication rules, and general pharmacy dispensing processes.


• Adaptability to evolving clinical guidelines, changing protocols, and new operational technology.

What SmithRx Offers You:

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance


• Flexible Spending Benefits


• 401(k) Retirement Savings Program


• Short-term and long-term disability


• Discretionary Paid Time Off


• Paid Company Holidays


• Wellness Benefits


• Commuter Benefits


• Paid Parental Leave benefits


• Employee Assistance Program (EAP)


• Well-stocked kitchen in office locations


• Professional development and training opportunities

Zone A includes the following locations:

• San Francisco Bay Area - California


• Metro New York City - Connecticut, New Jersey, New York and Pennsylvania

Zone A Pay Range$173,400—$204,000 USD

Zone B includes the following locations:

• California - outside of San Francisco Bay Area


• Metro Denver / Boulder - Colorado


• Metro District of Columbia - District of Columbia, Maryland, Virginia and West Virginia


• Metro Boston / Cambridge - Massachusetts and New Hampshire


• Metro Austin - Texas


• Metro Seattle - Washington

Zone B Pay Range$159,000—$187,000 USD

Zone C includes all other locations not listed above, including:

• Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Wisconsin, Wyoming


• Non metro Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Virginia, Washington, and West Virginia

Zone C Pay Range$144,500—$170,000 USD

Compensation & Benefits

• Base Salary: The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.


• Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity. SmithRx offers a variety of benefits to help you live well, including: time off programs, medical, dental, vision, mental health support, paid parental leave, life and disability insurance and 401(k).

Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process. In the meantime, feel free to explore our comprehensive benefits here.