SmithRx
Health-Tech
Lead,ClinicalReviewPharmacist
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“Lead, Clinical Review Pharmacist at SmithRx. Skills: Prior authorization review, Management, Process improvement, Cross-functional collaboration. Manage, coach, and mentor prior authorization Pharmacists. Drive and maintain regulatory, compliance, and accreditation standards”
Industry & Context.
Troubleshoot eligibility questions, claims adjudication, and benefit designs; Identify current process gaps and solve them using technology, process and people
What They're Looking For.
Must Have
5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review, 3-5+ years of management experience required, Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) required, Active Pharmacist License required
Nice to Have
Familiarity with various regulatory (ERISA, ACA, Medicare) and accreditation requirements (URAC, NCQA), Proficiency in Mac, MS Office, G-Suite required
What You'll Do.
and mentor prior authorization Pharmacists
Drive and maintain regulatory
and accreditation standards
Recruit and hire new team members
Lead training and onboarding for new team members
Provide day-to-day supervision and support
Manage team to meet target KPIs
Ensure efficient allocation of operations center resources
Identify and drive areas for operational process improvements
Motivate Pharmacist growth and performance
Drive quality member experiences
Responsible for scheduling to drive consistent capacity
Responsible for execution of goals and objectives
Collaborate with Pharmacists within the Pharmacy and Therapeutics Committee process
Participate in development of clinical criteria
Identify current process gaps and solve them
Serve as a change champion for new technology
How You'll Work.
Team & Collaboration
Cross-functional collaboration with other departments; Troubleshoot eligibility questions, claims adjudication, and benefit designs; Collaborate with Pharmacists within the Pharmacy and Therapeutics Committee process; Work with cross functional teams to further SmithRx’s mission, vision, values and goals
Communication Scope
Communicate clearly; Present complex information to members, clients, pharmacies, providers, and other teams internally
Full Job Description
Who We Are: SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country. We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values: Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new. Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always. Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise. Job Summary: SmithRx is looking for a motivated manager to help manage a team of Prior Authorization Pharmacists. This role is pivotal in driving daily performance of the prior authorization team by ensuring high quality reviews, adhering to turnaround times, and delivering exceptional member experiences. Your primary focus will be the coaching and mentoring of your team as well as drive performance through the measurement of key performance indicators. What You Will Do: Directly manage, coach, and mentor a team of prior aut
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