Clinical Review Quality Assurance Pharmacist
SmithRx
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Responsible for developing, defining, maintaining and instituting a prior authorization quality assurance program for the Pharmacy Technician and Pharmacist clinical review function
- Responsible for summarizing quality assurance activities and presenting to leadership and the Clinical Review Team
- Responsible for developing, maintaining and conducting an interrater reliability program
- Monitors clinical appeals to further enhance the prior authorization program
- Collaborate with Pharmacists within the Pharmacy and Therapeutics Committee and Criteria Review Committee process and participate in development of clinical criteria for medications requiring prior authorization
- Identifies opportunities for technology enhancements, process improvement or coaching for team members
- Collaborate with Clinical Review Business Analyst to support system enhancements
- Support Policy and Procedure development and maintenance
- Become a subject matter expert on department standards and processes
Requirements
- Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required
- Active Pharmacist License required
- 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 highly desired.
- Proficiency in Mac, MS Office, G-Suite required
- Active listening, conversational speaking skills, with a high degree of empathy
- Self-starter 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
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
prior authorizationquality assuranceinterrater reliabilityclinical appealsquality auditsquality assurance best practicesdrug product calculationspharmacy knowledgeprocess improvementtechnology enhancements
Soft Skills
active listeningconversational speakingempathyself-startermultitaskingprioritizationtime managementclear communicationpresentation skillsflexibility
Certifications
Bachelor’s degree in PharmacyDoctor of Pharmacy (PharmD)Active Pharmacist License