About this role.
SmithRx seeks a senior clinical pharmacy leader to manage prior-authorization review operations, quality assurance, medication policy, and PA platform improvements. The manager will lead a multidisciplinary team, oversee interrater reliability and performance audits, and support evidence-based formulary and P&T Committee activities. This role combines PharmD-level pharmacotherapy expertise with PBM/health-plan utilization management, technical rule configuration, and data governance. Success requires translating clinical and business requirements into compliant system changes, leading UAT and training, and improving operational metrics in a fast-paced health-tech setting.
Role DNA
A quick view of the complexity, pace, ownership and collaboration implied by the job description.
Job Complexity
5/5Pace & Pressure
4/5Autonomy Level
5/5Communication Load
5/5Salary analysis
Estimated compensation compared with the broader US market for similar roles.
Core skills
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Sample interview questions
I establish clear audit standards, routinely measure interrater reliability, analyze root causes of variation, and use targeted calibration and training to improve consistency. I also connect audit findings to policy clarification and system-rule updates so quality improvements are sustainable rather than dependent on manual review alone.
I work with clinical, operations, and technical stakeholders to convert policy criteria into structured decision logic, required documentation, workflow routing, and exception handling. I validate configurations through test cases and UAT, ensuring the final rules preserve clinical intent, comply with regulations, and minimize unnecessary manual work.
I would monitor turnaround time, approval and denial patterns, first-pass accuracy, interrater reliability, overturn rates, backlog, productivity, escalation themes, and member/provider experience indicators. I would segment the data by therapy class, reviewer, workflow, and rule version to identify actionable trends.
I would clarify the underlying clinical, regulatory, operational, and technical constraints, then document agreed requirements and decision owners. When tradeoffs are needed, I would use patient safety, compliance risk, and measurable operational impact as the decision framework, followed by thorough UAT and stakeholder communication.
I synthesize evidence, guidelines, utilization patterns, and implementation implications into concise recommendations. After committee decisions, I ensure criteria are unambiguous, define necessary exceptions and documentation requirements, and partner with operations and technology teams to translate the policy into workable PA processes.
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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