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Salary: USD 136,000 - 192,000 / annual
SmithRx is a venture-backed healthtech company disrupting the Pharmacy Benefit Management (PBM) sector with a next-generation drug acquisition platform. The company has onboarded hundreds of thousands of members since 2016 and is focused on transforming the U.S. healthcare system through technology, cost-saving innovation, and customer service.
You will serve as Manager of Clinical Review Operations and Quality Assurance, leading a multidisciplinary team responsible for the integrity, efficiency, and clinical strategy of the prior authorization (PA) ecosystem. This role bridges business requirements and technical execution, ensuring PA programs are safe, evidence-based, compliant, and operationally excellent.
Key responsibilities include:
- Leading and mentoring a high-performing team across QA, medication policy, and business analysis
- Directing the PA quality assurance program, including interrater reliability audits and team performance reviews
- Managing PA platform strategy, technical enhancements, data governance, and clinical rule configuration
- Providing pharmacotherapy expertise for P&T Committee activities, formulary management, and evidence-based medication policy development
- Driving technology enhancements and monitoring KPIs using data-driven insights
- Facilitating process documentation, leading User Acceptance Testing (UAT), and managing stakeholder training for system releases
You will work in a mission-driven, collaborative culture guided by values of integrity, courage, and teamwork. The role offers competitive benefits including medical, pharmacy, dental, vision, life insurance, 401(k), flexible PTO, paid parental leave, professional development, and wellness programs.
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, including ePA standards (NCPDP) and rule configuration (e.g., Banjo Health, 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
