Clinical Review Pharmacist

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $63 - $66 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

👻 Ghost score 0%

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SmithRx

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $20M Series B on 2022-03

Consulting • Insurance • Healthcare

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.

📋 Description

• 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 thorough records in accordance with URAC/NCQA utilization review standards • Provide support to members, prescribers, and pharmacies by responding to clinical inquiries • Stay current with clinical prescribing guidelines, internal policies, and regulatory changes • Follow internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security • Identify and report potential fraud, waste, and abuse • Support training and development of team members • Assist leadership with special projects, process improvements, and operational initiatives

🎯 Requirements

• 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 • Preferred: One year of prior authorization or utilization management experience • Preferred: One year experience in managed care or pharmacy benefit management (PBM) • Preferred: Direct experience conducting prior authorization reviews, clinical appeals, formulary exceptions, step therapy evaluations, and quantity limit reviews • Preferred: Experience in Google Workspace (Gmail, Docs, Sheets, and Drive)

🏖️ Benefits

• Time off programs • Medical insurance • Dental insurance • Vision insurance • Mental health support • Paid parental leave • Life insurance • Disability insurance • 401(k) • Potential eligibility for bonuses, commissions, or equity