Senior Clinical Review Operations Pharmacist

The role

This individual contributor will serve as a clinical subject matter expert and operational driver within the Prior Authorization team. You will build tools to support prior authorization evaluations, drive process improvements, and mentor peer pharmacists.

What you will do

• Identify operational process gaps and champion technology-driven solutions.
• Serve as a clinical peer lead providing guidance, coaching, and onboarding support to fellow pharmacists.
• Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals.
• Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances.
• Collaborate with clinical leadership and the Pharmacy and Therapeutics (P&T) Committee to develop and review clinical criteria.
• Meet or exceed individual target KPIs and turn-around-time (TAT) SLAs.
• Drive adoption of new technology, workflow tools, and updated clinical protocols.

Required qualifications

• 5+ years of health plan or Pharmacy Benefit Manager (PBM) experience involved in prior authorization review and clinical operations.
• Demonstrated expertise as a clinical subject matter expert in driving process improvements or technology-driven efficiencies.
• Active Pharmacist License (unrestricted).
• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD).
• Strong proficiency with Mac, MS Office, and G-Suite platforms.
• Excellent active listening and communication skills.
• Superior multitasking, time management, and problem-solving abilities.
• 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.

Benefits

• Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary Paid Time Off
• Paid Company Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities

About the company

SmithRx is a rapidly growing, venture-backed Health-Tech company. Their mission is to disrupt the Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform.