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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 seeking a Manager of Clinical Review and Quality Assurance to lead a multidisciplinary team.
In this role, you will oversee the integrity, efficiency, and clinical strategy of SmithRx's prior authorization (PA) ecosystem. You will mentor and unify a high-performing team across Quality Assurance, medication policy, and business analysis. Key responsibilities include directing the PA quality assurance program with interrater reliability audits and performance reviews; leading PA platform strategy, technical enhancements, data governance, and clinical rule configuration; providing pharmacotherapy expertise for P&T Committee activities and formulary management; driving process improvements through technology enhancements and data-driven insights; and facilitating change management including process documentation, User Acceptance Testing, and stakeholder training for system releases.
You will bridge the gap between business requirements and technical execution, ensuring PA programs are safe, evidence-based, compliant, and operationally excellent. The role requires deep expertise in clinical pharmacy within health plan or PBM environments, strong technical proficiency with PA platforms and ePA standards (NCPDP), and proven ability to translate complex data into actionable system changes. You will work in a mission-driven, collaborative culture focused on transforming the U.S. healthcare system.
