Clinical Review QA Pharmacist

Job not on LinkedIn

October 9

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

+16 more states

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌪️ Kansas – Remote 🎰 Nevada – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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SmithRx

WebsiteLinkedInAll Job Openings

Healthcare Insurance • SaaS • B2B

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $20M Series B on 2022-03

📋 Description

• Responsible for refining and maintaining a prior authorization quality assurance program for the Data Entry, Pharmacy Technician and Pharmacist clinical review function • Responsible for performing quality assurance reviews for pharmacists, pharmacy technicians, and data entry agents • Responsible for monthly presentation of quality assurance review results, including success stories and areas of opportunity to leadership and the Clinical Review Team • Responsible for developing, maintaining and conducting an interrater reliability (IRR) program • Participates as a member of the Quality Management Committee, along with cross functional teams including accreditation team, compliance team, etc • Reviews clinical review process documents to identify any gaps, and provide feedback where necessary • Collaborate with Clinical Review team members, technology team, and other cross functional teams to support system enhancements • Support and respond to quality related questions from cross functional teams within the organization • Become a subject matter expert on department standards and processes

🎯 Requirements

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required • Active Pharmacist License required, in good standing • 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review required • 2+ years of experience conducting prior authorization quality audits required • 2+ years of experience designing and developing quality assurance best practices in a startup environment are highly desired. • Experience with multiple lines of businesses (Commercial, Medicare, Medicaid) and regulatory standards that govern clinical review such as ERISA, State specific laws, CMS, ACA, MEWA is preferred • Proficiency with technology tools including MS Office and G-Suite. Advanced Excel analytics experience preferred. • Active listening, conversational speaking skills, with a high degree of empathy • Self-starter and problem solver with ability to multitask, prioritize and manage time effectively • Ability to communicate clearly, present complex information to members, clients, pharmacies, providers, and other teams internally • Flexibility and ability to adapt to changes and updates to processes and protocols • Demonstrate accurate drug product/dose calculations for appropriate claim adjudication and knowledge of general pharmacy and drug product information for the prescription filling process

🏖️ Benefits

• 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 • 12 Paid Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities