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Salary: USD 144,500 - 204,000 / 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-driven innovation and best-in-class customer service.
You will serve as a Senior Clinical Review Operations Pharmacist within the Prior Authorization team, functioning as a clinical subject matter expert and key operational driver. This is an individual contributor role with significant influence across clinical operations and cross-functional initiatives.
Key responsibilities include:
- Identifying operational process gaps and championing technology-driven solutions to improve throughput, scalability, and workflow efficiency in prior authorization reviews
- Serving as a clinical peer lead, providing guidance, coaching, and onboarding support to fellow pharmacists to ensure clinical consistency and quality
- Acting as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals
- Partnering with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances
- Collaborating with clinical leadership and the Pharmacy and Therapeutics (P&T) Committee to develop, refine, and review clinical criteria for medications requiring prior authorization
- Consistently meeting or exceeding individual target KPIs and turn-around-time (TAT) SLAs
- Driving adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team
You will work in a mission-driven, collaborative culture guided by values of integrity, courage, and teamwork. The role offers the opportunity to directly impact healthcare delivery and operational efficiency at scale.
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
- High degree of empathy with excellent active listening and communication skills to clearly convey complex clinical information to members, providers, and internal stakeholders
- Proven self-starter with superior multitasking, time management, and problem-solving abilities in a fast-paced environment
- 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
