Senior Clinical Review Operations Pharmacist

🔥 1 hour ago

🏈 Alabama, Alaska, +45 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – 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

💵 $144.5k - $204k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 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

• Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency. • Provide clinical guidance, coaching, and onboarding support to fellow pharmacists. • Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals. • Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances. • Collaborate with clinical leadership and the Pharmacy and Therapeutics Committee to develop, refine, and review clinical criteria for medications requiring prior authorization. • Meet or exceed individual target KPIs and turnaround-time SLAs. • Drive adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team.

🎯 Requirements

• 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. • Excellent active listening and communication skills to convey complex clinical information. • Superior multitasking, time management, and problem-solving abilities. • 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.

🏖️ Benefits

• Medical, Pharmacy, Dental, Vision, and Life Insurance • 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 • Bonuses, commissions, or equity may be available