Job Description

SmithRx is seeking a motivated Clinical Review Quality Assurance Pharmacist to develop and maintain a quality audit program for the Clinical Review Team. This role is crucial for ensuring high-quality prior authorization reviews, regulatory adherence, and excellent experiences for members, providers, and employees.

Responsibilities

• Refine and maintain a prior authorization quality assurance program
• Perform quality assurance reviews for pharmacists, technicians, and data entry agents
• Present monthly quality assurance review results to leadership
• Develop and conduct an interrater reliability program
• Participate in the Quality Management Committee
• Review clinical review process documents and provide feedback
• Collaborate with teams to support system enhancements
• Respond to quality-related questions
• Serve as a subject matter expert on department standards

Requirements

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD)
• Active Pharmacist License
• 5+ years of health plan or PBM experience in prior authorization review
• 2+ years of experience conducting prior authorization quality audits
• Experience with multiple lines of businesses (Commercial, Medicare, Medicaid)
• Proficiency with MS Office and G-Suite
• Strong communication and problem-solving skills
• Ability to adapt to changes

Benefits

• No benefits