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Lead, Clinical Review Pharmacist

1 week, 5 days ago
United States
Full-time
Lead
Operations Manager
Operations
Apply Now
SmithRx

SmithRx

SmithRx revolutionizes pharmacy benefits with transparent technology, connecting stakeholders for efficient drug delivery and cost savings.

Pharmaceuticals
1K-5K
Founded 2016
$38M raised
View All Jobs 40

Description

  • Directly manage, coach, and mentor a team of prior authorization pharmacists.
  • Provide day-to-day supervision, support, and escalation handling for pharmacists on the team.
  • Drive team performance against target KPIs, turnaround times, and quality standards.
  • Ensure compliance with regulatory, accreditation, policy, and procedure requirements.
  • Recruit, hire, train, and onboard new team members.
  • Schedule team coverage and manage capacity to maintain consistent operations.
  • Identify process gaps and lead operational improvements to support scale.
  • Collaborate cross-functionally on eligibility, claims adjudication, benefit design, and other operational issues.
  • Participate in Pharmacy and Therapeutics Committee work and help develop clinical criteria for prior authorization medications.
  • Serve as a change champion when new technology is introduced and help improve processes and efficiencies.

Requirements

  • 5+ years of experience in a health plan or pharmacy benefit manager role with prior authorization review experience.
  • 3-5+ years of management experience.
  • Experience with regulatory requirements such as ERISA, ACA, and Medicare.
  • Familiarity with accreditation standards such as URAC and NCQA.
  • Proficiency with Mac, MS Office, and G-Suite.
  • Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
  • Active Pharmacist License required.
  • Strong active listening and communication skills with a high degree of empathy.
  • Ability to multitask, prioritize, and manage time effectively in a fast-paced environment.
  • Ability to work accurately within protocols, follow escalation pathways, and adapt to process or technology changes.

Benefits

  • Medical, Pharmacy, Dental, Vision, Life Insurance, and AD&D Insurance.
  • Flexible Spending Benefits.
  • 401(k) Retirement Savings Program.
  • Short-term and long-term disability coverage.
  • Discretionary paid time off and paid company holidays.
  • Paid parental leave.
  • Employee Assistance Program (EAP).
  • Professional development and training opportunities.

Interested in this position?

Apply directly on the company website

Apply Now

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