Senior Clinical Review Operations Pharmacist

Remote

Smith Rx 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, Smith Rx 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 Smith Rx 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.

Smith Rx is looking for a motivated Senior Clinical Review Operations Pharmacist to serve as a clinical subject matter expert and key operational driver within our Prior Authorization team. This individual contributor role is pivotal in maintaining high-quality clinical reviews, ensuring adherence to turnaround times, and delivering exceptional member experiences. Your primary focus will be building tools to support prior authorization evaluations, driving process improvements, mentoring peer pharmacists on clinical protocols, and serving as a key cross-functional innovator to scale our clinical operations.

• Process & Technology Optimization: Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency.
• Clinical Mentorship & Quality Assurance: Serve as a clinical peer lead, providing guidance, coaching, and onboarding support to fellow pharmacists to foster clinical consistency and quality.
• Complex Escalations: Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals.
• Cross-Functional Collaboration: Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances.
• Clinical Policy & P&T Committee Support: Collaborate with clinical leadership and the Pharmacy and Therapeutics (P&T) Committee to help develop, refine, and review clinical criteria for medications requiring prior authorization.
• Performance & SLAs: Consistently meet or exceed individual target KPIs and turn-around-time (TAT) SLAs to maintain seamless operating standards.
• Change Champion: Drive adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team.

• 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.
• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
• Strong proficiency with Mac, MS Office, and G-Suite…