Lead Clinical Review Pharmacist

This is a fully remote position, open to applicants in United States.

📋 Description

• Directly oversee, guide, and mentor a team of prior authorization Pharmacists.

• Accountable for driving and sustaining regulatory, compliance, and accreditation standards within the clinical review team.

• Engage in the recruitment and hiring of new team members.

• Lead the training and onboarding processes for all new personnel.

• Provide daily supervision, support, and an escalation path for Pharmacists on your team.

• Manage the team to achieve target KPIs associated with our operational model.

• Ensure optimal allocation of operations center resources and uphold high performance standards.

• Identify and promote areas for operational process enhancements to facilitate scaling.

• Collaborate cross-functionally with other departments, including addressing eligibility inquiries, claims adjudication, and benefit designs.

• Inspire growth and performance among Pharmacists through coaching interactions.

• Enhance member experiences by ensuring adherence to Clinical Review team policies and procedures.

• Responsible for scheduling to maintain consistent capacity.

• Accountable for achieving the goals and objectives of direct reports.

• Collaborate with Pharmacists in the Pharmacy and Therapeutics Committee process and contribute to the development of clinical criteria for medications requiring prior authorization.

• Work alongside cross-functional teams to advance SmithRx’s mission, vision, values, and goals.

• Identify existing process gaps and resolve them through technology, process, and personnel enhancements.

• Act as a change champion when new technology is implemented, improving processes to scale the business and enhance efficiencies.

⛳️ Requirements

• A minimum of 5 years of experience in health plan or pharmacy benefit management, particularly in prior authorization review.

• Required management experience of 3 to 5 years.

• Familiarity with various regulatory (ERISA, ACA, Medicare) and accreditation standards (URAC, NCQA).

• Proficient in Mac, MS Office, and G-Suite.

• Possess active listening and conversational speaking skills, demonstrating a high level of empathy.

• Self-motivated with the capability to multitask, prioritize, and manage time efficiently.

• Ability to convey information clearly and present complex details to members, clients, pharmacies, providers, and other internal teams.

• Competence in working accurately within protocols and following appropriate escalation pathways for unique situations or when clarity is needed.

• Flexibility and adaptability to changes in technology, processes, and protocols.

• Demonstrable skills in accurate drug product/dose calculations for appropriate claim adjudication, alongside knowledge of general pharmacy and drug product information relevant to the prescription filling process.

• A Bachelor’s degree in Pharmacy or a Doctor of Pharmacy (PharmD) is required.

• An active Pharmacist License is mandatory.

🏝️ Benefits

• Highly competitive wellness benefits including 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 coverage.

• 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.

• Opportunities for professional development and training.