SmithRx
Clinical Review Quality Assurance Pharmacist
Remote Who We Are
SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the PBM sector by building a next-generation drug acquisition platform driven by technology, cost-saving tools, and best-in-class customer service. We have partnered with hundreds of thousands of members since 2016 and operate with a mission-driven, collaborative culture guided by our values: Integrity, Courage, and Together. Job Summary
SmithRx is looking for a motivated Clinical Review Quality Assurance Pharmacist to develop and maintain a quality audit program for the Clinical Review Team. This role supports the prior authorization team by ensuring high-quality reviews, regulatory adherence, and strong experiences for members, providers, and employees. What you will do
Refine and maintain a prior authorization quality assurance program for the Data Entry, Pharmacy Technician, and Pharmacist clinical review functions. Perform quality assurance reviews for pharmacists, pharmacy technicians, and data entry agents. Monthly presentation of QA results to leadership and the Clinical Review Team, including success stories and areas of opportunity. Develop, maintain, and conduct an interrater reliability (IRR) program. Participate as a member of the Quality Management Committee with cross-functional teams (accreditation, compliance, etc.). Review clinical review process documents to identify gaps and provide feedback. Collaborate with Clinical Review, technology, and cross-functional teams to support system enhancements. Support and respond to quality-related questions from cross-functional teams. Become a subject matter expert on department standards and processes. What you will bring to SmithRx
Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD). 5+ years of health plan or PBM experience, specifically in prior authorization review. 2+ years of experience conducting prior authorization quality audits. 2+ years designing and developing QA best practices in a startup environment (highly desirable). Experience with multiple lines of business (Commercial, Medicare, Medicaid) and regulatory standards (ERISA, state laws, CMS, ACA, MEWA) is preferred. Proficiency with MS Office and G-Suite; advanced Excel analytics is a plus. Strong communication, empathy, and ability to explain complex information clearly to members, clients, pharmacies, and internal teams. Self-starter, problem-solver, with ability to multitask, prioritize, and adapt to process changes. Knowledge of drug product/dose calculations for claim adjudication and general pharmacy information related to prescriptions. What SmithRx Offers You
Competitive wellness benefits (Medical, Pharmacy, Dental, Vision, Life Insurance, and AD&D). 401(k) Retirement Savings Program. Disability coverage (short-term and long-term). Discretionary Paid Time Off and 12 paid holidays. Paid parental leave and Employee Assistance Program (EAP). Well-stocked kitchen in office locations and opportunities for professional development and training.
#J-18808-Ljbffr
Remote Who We Are
SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the PBM sector by building a next-generation drug acquisition platform driven by technology, cost-saving tools, and best-in-class customer service. We have partnered with hundreds of thousands of members since 2016 and operate with a mission-driven, collaborative culture guided by our values: Integrity, Courage, and Together. Job Summary
SmithRx is looking for a motivated Clinical Review Quality Assurance Pharmacist to develop and maintain a quality audit program for the Clinical Review Team. This role supports the prior authorization team by ensuring high-quality reviews, regulatory adherence, and strong experiences for members, providers, and employees. What you will do
Refine and maintain a prior authorization quality assurance program for the Data Entry, Pharmacy Technician, and Pharmacist clinical review functions. Perform quality assurance reviews for pharmacists, pharmacy technicians, and data entry agents. Monthly presentation of QA results to leadership and the Clinical Review Team, including success stories and areas of opportunity. Develop, maintain, and conduct an interrater reliability (IRR) program. Participate as a member of the Quality Management Committee with cross-functional teams (accreditation, compliance, etc.). Review clinical review process documents to identify gaps and provide feedback. Collaborate with Clinical Review, technology, and cross-functional teams to support system enhancements. Support and respond to quality-related questions from cross-functional teams. Become a subject matter expert on department standards and processes. What you will bring to SmithRx
Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD). 5+ years of health plan or PBM experience, specifically in prior authorization review. 2+ years of experience conducting prior authorization quality audits. 2+ years designing and developing QA best practices in a startup environment (highly desirable). Experience with multiple lines of business (Commercial, Medicare, Medicaid) and regulatory standards (ERISA, state laws, CMS, ACA, MEWA) is preferred. Proficiency with MS Office and G-Suite; advanced Excel analytics is a plus. Strong communication, empathy, and ability to explain complex information clearly to members, clients, pharmacies, and internal teams. Self-starter, problem-solver, with ability to multitask, prioritize, and adapt to process changes. Knowledge of drug product/dose calculations for claim adjudication and general pharmacy information related to prescriptions. What SmithRx Offers You
Competitive wellness benefits (Medical, Pharmacy, Dental, Vision, Life Insurance, and AD&D). 401(k) Retirement Savings Program. Disability coverage (short-term and long-term). Discretionary Paid Time Off and 12 paid holidays. Paid parental leave and Employee Assistance Program (EAP). Well-stocked kitchen in office locations and opportunities for professional development and training.
#J-18808-Ljbffr