About this role.
SmithRx is seeking a senior PharmD leader to manage clinical review operations and quality assurance for its prior authorization ecosystem. The role combines people leadership, clinical utilization-management strategy, medication policy, QA auditing, and PA-platform configuration. The manager will oversee technical enhancements, data governance, UAT, release training, and performance improvement across a multidisciplinary team. Candidates need an active unrestricted pharmacist license, at least 10 years of clinical pharmacy experience in a health plan or PBM setting, and significant prior-authorization platform expertise.
Role DNA
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Job Complexity
5/5Pace & Pressure
5/5Autonomy Level
5/5Communication Load
5/5Salary analysis
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Core skills
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Sample interview questions
I would establish clear decision standards, conduct routine interrater reliability audits, identify variance drivers, and implement targeted calibration and training. I would track error themes and turnaround-time measures through dashboards, then validate that corrective actions improve both accuracy and consistency.
I begin by clarifying the clinical intent, evidence base, member impact, and regulatory requirements with policy and clinical stakeholders. I convert those requirements into documented decision logic, configure and test the rules with technical partners, run UAT against representative cases, and maintain change-control documentation before release.
I would prepare evidence-based clinical analyses and ensure recommendations reflect formulary strategy, safety, cost considerations, and applicable regulations. Before final approval, I would assess operational feasibility, define implementation requirements, and confirm that PA criteria and system rules can accurately execute the committee’s decision.
I would monitor approval and denial accuracy, interrater reliability, audit defect rates, turnaround time, first-pass adjudication, backlog volume, appeal and overturn trends, and policy-to-configuration defects. I would segment results by medication class, reviewer, workflow, and rule to prioritize improvement efforts.
I use a structured release plan with documented requirements, risk assessment, stakeholder ownership, UAT acceptance criteria, training materials, and a defined communication cadence. After launch, I closely monitor production metrics and user feedback, maintain an escalation path for defects, and conduct a retrospective to strengthen future releases.
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: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
- Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
- Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.
Job Summary:
SmithRx is looking for a dynamic and experienced leader to serve as the Manager, Clinical Review Operations and Quality Assurance. This pivotal role is responsible for the integrity, efficiency, and clinical strategy of our prior authorization (PA) ecosystem. You will lead a multidisciplinary function, integrating Quality Assurance (QA) oversight, technical system management, and medication policy execution. You will bridge the gap between business requirements and technical execution, ensuring that our PA programs are safe, evidence-based, compliant, and operationally excellent.
What you will do:
- Team Leadership: Mentor and unify a high-performing team across QA, medication policy, and business analysis to drive organizational goals.
- Quality Assurance: Direct the PA quality assurance program, overseeing interrater reliability audits and reviewing team performance.
- Platform Management: Lead PA platform strategy, technical enhancements, data governance, and clinical rule configuration for optimal efficiency.
- Clinical Strategy: Provide pharmacotherapy expertise for P&T Committee activities, formulary management, and evidence-based medication policy development.
- Process Improvement: Drive technology enhancements and monitor key performance metrics using data-driven insights.
- Change Management: Facilitate process documentation, lead User Acceptance Testing (UAT), and manage stakeholder training for system releases.
What you will bring to SmithRx:
- Education: Doctor of Pharmacy (PharmD) required.
- Licensure: Active, unrestricted Registered Pharmacist (RPh) license.
- Experience: 10+ years in clinical pharmacy, specifically within Health Plan or PBM environments.
- Technical Proficiency: 5+ years supporting PA platforms, including ePA standards (NCPDP) and rule configuration (e.g., Banjo Health, MHK).
- Domain Expertise: Strong background in QA best practices, clinical utilization review, P&T committee support, and regulatory compliance.
- Analytical Skills: Proven ability to translate complex data and business requirements into actionable system changes.
- Soft Skills: Exceptional communication and influencing skills with a bias for action in fast-paced environments.
What SmithRx Offers You:
- 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
- Paid Company Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities
Zone A includes the following locations:
- San Francisco Bay Area – California
- Metro New York City – Connecticut, New Jersey, New York and Pennsylvania
Zone A Pay Range
$163,200—$192,000 USD
Zone B includes the following locations:
- California – outside of San Francisco Bay Area
- Metro Denver / Boulder – Colorado
- Metro District of Columbia – District of Columbia, Maryland, Virginia and West Virginia
- Metro Boston / Cambridge – Massachusetts and New Hampshire
- Metro Austin – Texas
- Metro Seattle – Washington
Zone B Pay Range
$149,600—$176,000 USD
Zone C includes all other locations not listed above, including:
- Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Wisconsin, Wyoming
- Non metro Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Virginia, Washington, and West Virginia
Zone C Pay Range
$136,000—$160,000 USD
Compensation & Benefits
- Base Salary: The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.
- Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity. SmithRx offers a variety of benefits to help you live well, including: time off programs, medical, dental, vision, mental health support, paid parental leave, life and disability insurance and 401(k).
Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process. In the meantime, feel free to explore our comprehensive benefits here.
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