[Remote] Clinical Review Quality Assurance Pharmacist at SmithRx

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

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

Responsibilities

Refining and maintaining a prior authorization quality assurance program for the Data Entry, Pharmacy Technician and Pharmacist clinical review function
Performing quality assurance reviews for pharmacists, pharmacy technicians, and data entry agents
Monthly presentation of quality assurance review results, including success stories and areas of opportunity to leadership and the Clinical Review Team
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

Skills

SmithRx

Pharmacy benefit management with transparent pricing

About SmithRx

SmithRx operates as a Pharmacy Benefit Manager (PBM) that focuses on managing prescription drug plans for self-insured employers and plan sponsors. The company uses a transparent pricing model called "Pass Through Pricing," where it charges only an administrative fee and passes all rebates from prescriptions directly to clients and their members. This model contrasts with traditional PBMs that often inflate drug prices and retain rebates for profit. SmithRx's clients benefit from a technology platform that utilizes real-time data to improve service delivery, ensuring efficient and high-quality pharmacy benefit management. The company also provides a concierge service to enhance support for both members and clients. SmithRx aims to simplify pharmacy benefits while maximizing value for its clients through transparency, advanced technology, and exceptional customer service.

San Francisco, CaliforniaHeadquarters

2016Year Founded

$94.8MTotal Funding

SERIES_CCompany Stage

HealthcareIndustries

201-500Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account/Flexible Spending Account

Unlimited Paid Time Off

Paid Holidays

Wellness Program

Commuter Benefits

Parental Leave

Mental Health Support

Professional Development Budget

Risks

Increased competition from technology-driven PBMs like Capital Rx could erode market share.

Rapid technological advancements may require costly updates to SmithRx's platform.

Potential regulatory scrutiny on PBM pricing models could impact SmithRx's business model.

Differentiation

SmithRx uses a transparent 'Pass Through Pricing' model, unlike traditional PBMs.

The company leverages real-time data for efficient pharmacy benefit management services.

SmithRx offers concierge-level service, enhancing customer satisfaction and support.

Upsides

SmithRx secured $60M in Series C funding, indicating strong investor confidence.

Partnership with Banjo Health enhances prior authorization processes using AI technology.

Collaboration with TheracosBio offers cost-effective drug options for Type 2 Diabetes.

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