Clinical Review Quality Assurance Pharmacist - Remote

Overview

SmithRx is a rapidly growing, venture-backed Health-Tech company dedicated to transforming the Pharmacy Benefit Management sector through innovative technology and exceptional customer service.

In Short

• Develop and maintain a quality audit program for the Clinical Review Team.
• Perform quality assurance reviews for pharmacists and pharmacy technicians.
• Present quality assurance review results to leadership and the Clinical Review Team.
• Conduct an interrater reliability (IRR) program.
• Collaborate with cross-functional teams including compliance and accreditation.
• Identify gaps in clinical review processes and provide feedback.
• Support quality-related inquiries from various teams.
• Become a subject matter expert on department standards.

Requirements

• Bachelor’s degree in Pharmacy or PharmD required.
• Active Pharmacist License required.
• 5+ years of experience in health plans or pharmacy benefit management.
• 2+ years of experience conducting prior authorization quality audits.
• Experience in designing quality assurance best practices in a startup environment.
• Knowledge of regulatory standards for clinical review.
• Proficiency in MS Office and G-Suite, advanced Excel preferred.
• Strong communication and problem-solving skills.
• Ability to multitask and manage time effectively.
• Knowledge of drug product information and calculations.

Benefits

• Competitive wellness benefits including Medical, Dental, and Vision insurance.
• 401(k) Retirement Savings Program.
• Discretionary Paid Time Off and 12 Paid Holidays.
• Flexible Spending Benefits.
• Short-term and long-term disability coverage.
• Paid Parental Leave benefits.
• Professional development and training opportunities.
• Employee Assistance Program (EAP).