Clinical Review Pharmacist

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:

Joining SmithRx’s clinical team, the Clinical Review Pharmacist plays a key role in enhancing clinical offerings and improving outcomes for our members and clients. Operating in a collaborative and fast-paced environment, this position pairs clinical expertise with service excellence to review prior authorization requests, support clinical programs, and offer guidance to providers, pharmacies, and members.

What you will do:

• Review and make timely, evidence-based decisions on prior authorizations and appeals using clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across applicable lines of businesses .
• Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries, demonstrating professionalism, active listening, and a patient-centered approach.
• Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.