
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.
🔥 6 minutes ago
🌵 Arizona, Florida, +8 more states – Remote
💵 $22 / hour
⏳ Contract/Temporary
🟢 Junior
🟡 Mid-level
💊 Pharmacist
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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.
• Assist members, providers, pharmacies, and internal SmithRx teams with prescription complexities and timely coverage of clinically appropriate, cost-effective medication therapy • Verify eligibility and drug coverage under plan benefit designs for appropriate claims processing • Triage clinical review processes for prior authorization requests according to established protocols • Review prior authorization requests using criteria, claims history, and plan benefit rules • Conduct prescriber and pharmacy outreach to verify and gather required information • Organize and prioritize requests for timely prior authorization case management • Build and adjust authorizations within the claim adjudication system • Navigate drug products and formulations and perform basic calculations to monitor accurate claims adjudication • Coordinate outreach across teams and address questions and escalations • Evaluate clinical situations against medication policies and approve or triage cases to a Pharmacist for denial • Determine when medications require internal or external review • Contact selected external stakeholders for approval on drugs with dollar limits
• High School diploma or GED or equivalent work experience • Active Pharmacy Technician license required • 2-4 years of experience as a Pharmacy Technician • Experience in prior authorization review, specifically working on the approval side at a PBM or health plan, preferred • Proficiency in Mac, MS Office, and G-Suite required • Critical thinking to navigate complex customized benefit plans and make sound clinical decisions • Active listening and conversational speaking skills, with a high degree of empathy • Ability to multitask, prioritize, and manage time effectively • Ability to communicate clearly and present complex information to members, clients, pharmacies, providers, and internal teams • Ability to work accurately within protocols and follow appropriate escalation pathways
• 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 • Remote contract employment
Apply Now🕒 September 30
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