SmithRx - Senior Clinical Review Operations Pharmacist

• Process & Technology Optimization: Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency. • Process & Technology Optimization: • Clinical Mentorship & Quality Assurance: Serve as a clinical peer lead, providing guidance, coaching, and onboarding support to fellow pharmacists to foster clinical consistency and quality. • Clinical Mentorship & Quality Assurance: • Complex Escalations: Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals. • Complex Escalations: • Cross-Functional Collaboration: Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances. • Cross-Functional Collaboration: • Clinical Policy & P&T Committee Support: Collaborate with clinical leadership and the Pharmacy and Therapeutics (P&T) Committee to help develop, refine, and review clinical criteria for medications requiring prior authorization. • Clinical Policy & P&T Committee Support: • Performance & SLAs: Consistently meet or exceed individual target KPIs and turn-around-time (TAT) SLAs to maintain seamless operating standards. • Performance & SLAs: • Change Champion: Drive adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team. • Change Champion: • 5+ years of health plan or Pharmacy Benefit Manager (PBM) experience, specifically involved in prior authorization review and clinical operations. • Demonstrated expertise as a clinical subject matter expert with a track record of driving process improvements or technology-driven efficiencies. • Active Pharmacist License (unrestricted) required. • Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required. • Strong proficiency with Mac, MS Office, and G-Suite platforms. • High degree of empathy with excellent active listening and communication skills to clearly convey complex clinical information to members, providers, and internal stakeholders. • Proven self-starter with superior multitasking, time management, and problem-solving abilities in a fast-paced environment. • Deep understanding of drug product/dose calculations, claim adjudication rules, and general pharmacy dispensing processes. • Adaptability to evolving clinical guidelines, changing protocols, and new operational technology. • What SmithRx Offers You: • 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 • 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 • Professional development and training opportunities • Zone A includes the following locations: • San Francisco Bay Area - California • Metro New York City - Connecticut, New Jersey, New York and Pennsylvania