Clinical Review Pharmacist (Seasonal)

The Clinical Review Pharmacist will complete prior authorization reviews for all lines of business and edit types, and respond to escalations from other internal departments. They will apply clinical judgment to evaluate member clinical situations against medication policies and plan benefit design to make coverage determinations, including identifying covered alternatives. Responsibilities also include organizing and prioritizing multiple requests to ensure timely prior authorization case management, building and adjusting authorizations under protocol within the claim adjudication system, and triaging, assessing, and responding to inquiries from various internal teams regarding claims processing and prior authorization requests. The role involves maintaining open communication with other functional areas within SmithRx and effectively communicating the company's vision, mission, values, and goals.