Lead, Clinical Review Pharmacist

About the role

SmithRx is a rapidly growing, venture-backed Health-Tech company focused on disrupting the Pharmacy Benefit Management (PBM) sector. Founded in 2016, SmithRx has onboarded hundreds of thousands of members and prides itself on its mission-driven and collaborative culture. The company is guided by core values of Integrity, Courage, and Together.

Responsibilities

• Directly manage, coach, and mentor a team of prior authorization Pharmacists
• Drive and maintain regulatory, compliance, and accreditation standards on the clinical review team
• Recruit and hire new team members
• Lead training and onboarding for all new team members
• Provide day-to-day supervision, support, and escalation path for Pharmacists on your team
• Manage team to meet target KPIs associated with our operating model
• Ensure efficient allocation of operations center resources and maintain high performance standards
• Identify and drive areas for operational process improvements to support scale
• Cross-functional collaboration with other departments including troubleshooting eligibility questions, claims adjudication, and benefit designs
• Motivate Pharmacist growth and performance through coaching interactions
• Drive quality member experiences by ensuring Clinical Review team policy and procedures are adhered to
• Responsible for scheduling to drive consistent capacity
• Responsible for execution of goals, and objectives of direct reports
• Collaborate with Pharmacists within the Pharmacy and Therapeutics Committee process and participate in development of clinical criteria for medications requiring prior authorization
• Work with cross functional teams to further SmithRx’s mission, vision, values and goals
• Identify current process gaps and solve them using technology, process and people
• When new technology is delivered, serve as a change champion and improve processes to scale the business and drive efficiencies

Requirements

• 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review
• 3-5+ years of management experience required
• Familiarity with various regulatory (ERISA, ACA, Medicare) and accreditation requirements (URAC, NCQA)
• Proficiency in Mac, MS Office, G-Suite required
• Active listening, conversational speaking skills, with a high degree of empathy
• Self-starter with ability to multitask, prioritize and manage time effectively
• Ability to communicate clearly, present complex information to members, clients, pharmacies, providers, and other teams internally
• Able to work accurately within protocols and follow appropriate escalation pathways for unique situations or where clarification is needed
• Flexibility and ability to adapt to changes and updates to technology, processes and protocols
• Demonstrate accurate drug product/dose calculations for appropriate claim adjudication and knowledge of general pharmacy and drug product information for the prescription filling process
• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required
• Active Pharmacist License required

Qualifications

• 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
• Paid Company Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Professional development and training opportunities