Job description
Who We Are:
SmithRx 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, SmithRx 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 SmithRx 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.
Job Summary:
Joining SmithRx’s clinical team, the Clinical Review Pharmacist plays a key role in enhancing clinical offerings and improving outcomes for our members and clients. Operating in a collaborative and fast-paced environment, this position pairs clinical expertise with service excellence to review prior authorization requests, support clinical programs, and offer guidance to providers, pharmacies, and members.
What you will do:
Review and make timely, evidence-based decisions on prior authorizations and appeals using clinical guidelines and benefit criteria.
Ensure compliance with federal, state, and internal regulations across applicable lines of businesses .
Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries, demonstrating professionalism, active listening, and a patient-centered approach.
Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
Identify and report potential fraud, waste, and abuse (FWA).
Support training and development of new and existing team members as needed.
Assist leadership with special projects, process improvements, and operational initiatives
What you will bring to SmithRx:
Minimum Qualifications:
Doctor of Pharmacy (PharmD.) or Bachelor of Science in Pharmacy (B.S. Pharm) from an ACPE-accredited school of pharmacy
Active, unrestricted, pharmacist license in state of residence
Minimum of 2 years of pharmacy practice experience
Strong communication, writing, and organizational skills
Ability to manage multiple priorities in a high-volume, metric-driven environment
General understanding of drug information, clinical guidelines, formulary design, and utilization management strategies
Flexible and adaptable to changes
Availability to work after hours, weekends, and holidays on a rotating or fixed schedule
Preferred Qualifications:
One year of prior authorization or utilization management experience
One year experience in managed care or pharmacy benefit management (PBM)
Direct experience conducting prior authorization reviews, clinical appeals, formulary exceptions, step therapy evaluations, and quantity limit reviews
Experience in Google Workspace (Gmail, Docs, Sheets, and Drive)
Zone A includes the following locations:
San Francisco Bay Area - California
Metro New York City - Connecticut, New Jersey, New York and Pennsylvania
Zone A Pay Range
$64—$66 USD
Zone B includes the following locations:
California - outside of San Francisco Bay Area
Metro Denver / Boulder - Colorado
Metro District of Columbia - District of Columbia, Maryland, Virginia and West Virginia
Metro Boston / Cambridge - Massachusetts and New Hampshire
Metro Austin - Texas
Metro Seattle - Washington
Zone B Pay Range
$63—$65 USD
Zone C includes all other locations not listed above, including:
Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Wisconsin, Wyoming
Non metro Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Virginia, Washington, and West Virginia
Zone C Pay Range
$63—$65 USD
Compensation & Benefits
Base Salary: The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.
Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity. SmithRx offers a variety of benefits to help you live well, including: time off programs, medical, dental, vision, mental health support, paid parental leave, life and disability insurance and 401(k).
Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process. In the meantime, feel free to explore our comprehensive benefits here.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.