Clinical Review Pharmacist (Seasonal)
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: Always operate with honesty and transparency so we earn the trust of our clients.
- Courage: Demonstrate the courage needed to take on a broken industry and continuously improve what we offer to optimize health outcomes.
- Together: Foster a collaborative and inclusive environment that values teamwork, respect, and open communication, and encourages creativity and diversity of thought.
Job Summary: As a part of the clinical services team, the Clinical Review Pharmacist will join the company's clinical team to help optimize the SmithRx clinical offerings and outcomes for our customers, members and clients. In order to be eligible for this position applicants must be based in one of the following states: Arkansas, Arizona, California, Colorado, Florida, Georgia, Kansas, Minnesota, Missouri, Nevada, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin. This a seasonal role with a contract length of 6-months; opportunity for conversion to full-time is available based on performance and business need. New hires will receive a laptop for the work assignment and will be eligible for competitive benefits through our staffing vendor. What you will do:
- Complete prior authorization reviews for all lines of businesses and all edit types
- Responds to escalations from other internal departments
- Apply clinical judgment to evaluate member clinical situation against medication policies and plan benefit design to make coverage determinations for approval or denial, including identification of covered alternatives.
- Organize and prioritize multiple requests internally and externally to ensure timely prior authorization case management.
- Build and adjust authorizations under protocol within the claim adjudication system
- Triage, assess and respond to pharmacy technicians, member support, account management, benefit/plan operations and document management specialist inquiries regarding claims processing and prior authorization requests
- Maintain open lines of communication with other functional areas within SmithRx
- Provide effective communication of SmithRx's vision, mission, values and goals
What you will bring to SmithRx:
- Bachelor's Degree in Pharmacy or PharmD required
- 2-5 years pharmacy experience
- Clear, active pharmacist license
- Preferred: 1 year experience with prior authorizations for commercial plans
- Strong clinical skills with the ability to apply sound clinical judgment to a variety of complex situations
- Proficiency in drug literature and clinical trial evaluation, including electronic databases such as Micromedex, Medline, and UptoDate
- Emphasis on problem solving skills, including identifying and accepting a challenging situation and proposing a solution
- Proficiency in MS Word, Excel, and Powerpoint including tables, charts and figures preferred
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