Lead, Clinical Review Pharmacist

Job Description

Job Description

Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:

• Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
• Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
• Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.

Job Summary:

SmithRx is looking for a motivated manager to help manage a team of Prior Authorization Pharmacists. This role is pivotal in driving daily performance of the prior authorization team by ensuring high quality reviews, adhering to turnaround times, and delivering exceptional member experiences. Your primary focus will be the coaching and mentoring of your team as well as drive performance through the measurement of key performance indicators.

What You Will Do:

• Directly manage, coach, and mentor a team of prior authorization Pharmacists
• Responsible for driving and maintaining 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
• Motivates 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 service as a change champion and improve processes to scale the business and drive efficiencies

What You Will Bring:

• 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
• Ability 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

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