Manager, Clinical Review and Quality Assurance in the USA
SmithRx, a venture-backed health-tech company transforming the Pharmacy Benefit Management (PBM) sector, is seeking a senior-level Manager, Clinical Review and Quality Assurance for a remote or U.S.-based management role. This position carries a salary of $163,200 and sits at the intersection of clinical strategy, technical system management, and quality assurance oversight for the company's prior authorization (PA) ecosystem.
Core Responsibilities
- Lead, mentor, and unify a multidisciplinary team across QA, medication policy, and business analysis.
- Direct the PA quality assurance program, including interrater reliability audits and performance reviews.
- Manage PA platform strategy, technical enhancements, data governance, and clinical rule configuration.
- Provide pharmacotherapy expertise for P&T Committee activities, formulary management, and evidence-based medication policy development.
- Monitor key performance metrics, facilitate process documentation, lead User Acceptance Testing (UAT), and manage stakeholder training.
Requirements and Qualifications
- Doctor of Pharmacy (PharmD) degree and an active, unrestricted Registered Pharmacist (RPh) license.
- 10+ years of experience in clinical pharmacy within Health Plan or PBM environments.
- 5+ years of experience supporting PA platforms, NCPDP ePA standards, and rule configuration tools such as Banjo Health or MHK.
- Demonstrated background in QA best practices, clinical utilization review, P&T committee support, and regulatory compliance.
Benefits and Perks
SmithRx offers a comprehensive compensation package featuring medical, pharmacy, dental, vision, life, and AD&D insurance, alongside short-term and long-term disability coverage. Employees also benefit from a 401(k) retirement savings program, flexible spending accounts, commuter benefits, discretionary paid time off, and paid company holidays.