Lead, Clinical Review Pharmacist

About the Role

The day-to-day responsibilities of this role will involve directly managing, coaching, and mentoring a team of pharmacists, as well as driving and maintaining regulatory, compliance, and accreditation standards. You will be responsible for recruiting and hiring new team members, leading training and onboarding, and providing day-to-day supervision and support. Your goal will be to ensure that your team meets target KPIs, allocates operations center resources efficiently, and maintains high performance standards.

As part of the SmithRx team, you will be part of a mission-driven and collaborative culture that inspires employees to do their best work. The company values integrity, courage, and a commitment to working together to achieve its goals. This is a dynamic and fast-paced environment that requires a self-starter with excellent communication skills, the ability to multitask, and a strong sense of empathy.

What You Will Do

• Directly manage, coach, and mentor a team of prior authorization pharmacists to ensure high-quality reviews and exceptional member experiences.
• Drive and maintain regulatory, compliance, and accreditation standards on the clinical review team.
• Recruit and hire new team members to grow and develop the team.
• Lead training and onboarding for all new team members to ensure a smooth transition.
• Provide day-to-day supervision, support, and escalation paths for pharmacists on your team.
• Manage the team to meet target KPIs associated with the 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.
• Collaborate with cross-functional teams, including troubleshooting eligibility questions, claims adjudication, and benefit designs.
• Motivate 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.

What We Are Looking For

• 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review.
• 3-5+ years of management experience required, with a proven track record of leading high-performing teams.
• Familiarity with various regulatory requirements, such as ERISA, ACA, and Medicare, and accreditation requirements, such as URAC and NCQA.
• Proficiency in Mac, MS Office, and G-Suite.
• Active listening and conversational speaking skills, with a high degree of empathy.
• Self-starter with the ability to multitask, prioritize, and manage time effectively.
• Ability to work in a fast-paced environment and adapt to changing priorities.
• Strong analytical and problem-solving skills, with attention to detail.

Nice to Have

• Experience with digital health technologies and platforms.
• Knowledge of clinical criteria development for medications requiring prior authorization.
• Certification in a relevant field, such as pharmacy or healthcare management.
• Experience working in a remote or distributed team environment.
• Familiarity with project management tools and software.

Benefits and Perks

• Competitive salary and benefits package.
• Opportunity to work with a rapidly growing, venture-backed Health-Tech company.
• Collaborative and mission-driven work environment.
• Professional development and growth opportunities.
• Flexible working hours and remote work options.
• Access to cutting-edge technology and tools.
• Comprehensive health insurance and wellness programs.
• Generous paid time off and holiday package.

• When applying for this role, be sure to highlight your experience in prior authorization review and team management, as these are key requirements for the position.
• Familiarize yourself with SmithRx's company values and mission, and be prepared to discuss how your own values and goals align with those of the company.
• In your application materials, emphasize your ability to work in a fast-paced environment and adapt to changing priorities, as this is a key aspect of the role.
• Be prepared to provide specific examples of your experience with regulatory requirements and accreditation standards, and how you have applied these in your previous roles.
• Consider creating a portfolio or examples of your work in prior authorization review and team management, as this can help to demonstrate your skills and experience to the hiring team.
• When negotiating salary, be sure to research the market rate for similar roles in the Health-Tech industry, and be prepared to discuss your expectations and requirements.
• Be aware of potential red flags, such as a lack of clarity around the company's goals or values, or unrealistic expectations around work hours or workload.