Who We Are:
SmithRx is a pioneering Health-Tech company that is reinventing the Pharmacy Benefit Management (PBM) sector. Since 2016, we have transformed thousands of health plan members into successful clients, leveraging cutting-edge technology and innovative tools to deliver a better, more efficient service to our customers. Our mission-driven and collaborative culture inspires us to make healthcare transformation a reality every day.
At our core, we are guided by our company values:
- Integrity: Our purpose guides our actions and gives us confidence in the path ahead. 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 seeking a highly experienced and strategic Leader to join our team as the Manager, Clinical Review Operations and Quality Assurance. This role is pivotal in ensuring the integrity, efficiency, and clinical strategy of our Prior Authorization (PA) ecosystem. You will lead a multidisciplinary function, integrating Quality Assurance (QA) oversight, technical system management, and medication policy execution. Your responsibilities will include driving the PA quality assurance program, overseeing interrater reliability audits, and leading the development of evidence-based medication policies. You will bridge the gap between business requirements and technical execution, ensuring that our PA programs are safe, efficient, and compliant.
What You Will Do:
- Team Leadership: Mentor and unify a high-performing team across QA, medication policy, and business analysis to drive organizational goals.
- Quality Assurance: Direct the PA quality assurance program, overseeing interrater reliability audits and reviewing team performance.
- Platform Management: Lead PA platform strategy, technical enhancements, data governance, and clinical rule configuration for optimal efficiency.
- Clinical Strategy: Provide pharmacotherapy expertise for P&T Committee activities, formulary management, and evidence-based medication policy development.
- Process Improvement: Drive technology enhancements and monitor key performance metrics using data-driven insights.
- Change Management: Facilitate process documentation, lead User Acceptance Testing (UAT), and manage stakeholder training for system releases.
What You Will Bring to SmithRx:
- Education: Doctor of Pharmacy (PharmD) required.
- Licensure: Active, unrestricted Registered Pharmacist (RPh) license.
- Experience: 10+ years in clinical pharmacy, specifically within Health Plan or PBM environments.
- Technical Proficiency: 5+ years supporting PA platforms, including ePA standards (NCPDP) and rule configuration (e.g., Banjo Health, MHK).
- Domain Expertise: Strong background in QA best practices, clinical utilization review, P&T committee support, and regulatory compliance.
- Analytical Skills: Proven ability to translate complex data and business requirements into actionable system changes.
- Soft Skills: Exceptional communication and influencing skills with a bias for action in fast-paced environments.
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
Location Details:
- SmithRx is located in various regions, including the San Francisco Bay Area, Metro New York City
