Manager, Clinical Review and Quality Assurance

Job not on LinkedIn

🔥 0 minutes ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $136k - $192k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 2%

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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

• Mentor and unify a high-performing team across QA, medication policy, and business analysis to drive organizational goals • Direct the prior authorization quality assurance program, overseeing interrater reliability audits and reviewing team performance • Lead prior authorization platform strategy, technical enhancements, data governance, and clinical rule configuration • Provide pharmacotherapy expertise for P&T Committee activities, formulary management, and evidence-based medication policy development • Drive technology enhancements and monitor key performance metrics using data-driven insights • Facilitate process documentation, lead User Acceptance Testing (UAT), and manage stakeholder training for system releases • Ensure prior authorization programs are safe, evidence-based, compliant, and operationally excellent

🎯 Requirements

• Doctor of Pharmacy (PharmD) required • Active, unrestricted Registered Pharmacist (RPh) license • 10+ years in clinical pharmacy, specifically within Health Plan or PBM environments • 5+ years supporting PA platforms • Experience with ePA standards (NCPDP) and rule configuration, such as Banjo Health and MHK • Strong background in QA best practices, clinical utilization review, P&T committee support, and regulatory compliance • Proven ability to translate complex data and business requirements into actionable system changes • Exceptional communication and influencing skills with a bias for action in fast-paced environments

🏖️ 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 • 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 • Time off programs • Mental health support