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Clinical Review Quality Assurance Pharmacist
Clinical Review Quality Assurance PharmacistSmithRx • Plano, TX, US
Clinical Review Quality Assurance Pharmacist

Clinical Review Quality Assurance Pharmacist

SmithRx • Plano, TX, US
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

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 Clinical Review Quality Assurance Pharmacist to develop and maintain a quality audit program for the Clinical Review Team. This role is pivotal to the prior authorization team for ensuring high quality reviews, adherence to regulatory requirements, and delivery of exceptional member, provider and employee experiences.

What you will do :

  • Responsible for refining and maintaining a prior authorization quality assurance program for the Data Entry, Pharmacy Technician and Pharmacist clinical review function
  • Responsible for performing quality assurance reviews for pharmacists, pharmacy technicians, and data entry agents
  • Responsible for monthly presentation of quality assurance review results, including success stories and areas of opportunity to leadership and the Clinical Review Team
  • Responsible for developing, maintaining and conducting an interrater reliability (IRR) program
  • Participates as a member of the Quality Management Committee, along with cross functional teams including accreditation team, compliance team, etc
  • Reviews clinical review process documents to identify any gaps, and provide feedback where necessary
  • Collaborate with Clinical Review team members, technology team, and other cross functional teams to support system enhancements
  • Support and respond to quality related questions from cross functional teams within the organization
  • Become a subject matter expert on department standards and processes

    • What you will bring to SmithRx :

  • Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) required
  • Active Pharmacist License required, in good standing
  • 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review required
  • 2+ years of experience conducting prior authorization quality audits required
  • 2+ years of experience designing and developing quality assurance best practices in a startup environment are highly desired.
  • Experience with multiple lines of businesses (Commercial, Medicare, Medicaid) and regulatory standards that govern clinical review such as ERISA, State specific laws, CMS, ACA, MEWA is preferred
  • Proficiency with technology tools including MS Office and G-Suite. Advanced Excel analytics experience preferred.
  • Active listening, conversational speaking skills, with a high degree of empathy
  • Self-starter and problem solver 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
  • Flexibility and ability to adapt to changes and updates to 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

    • 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
  • 12 Paid Holidays
  • Wellness Benefits
  • Commuter Benefits
  • Paid Parental Leave benefits
  • Employee Assistance Program (EAP)
  • Well-stocked kitchen in office locations
  • Professional development and training opportunities
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