Clinical Review Pharmacist – Seasonal

SmithRx

. Review and make timely, evidence-based decisions on prior authorizations and appeals using clinical guidelines and benefit criteria .

Posted 9/29/2026full-timeRemote • United StatesJuniorMid-Level💰 $63 - $66 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical decision-making, prior authorization processes, and compliance with regulatory standards. Proficient in providing empathetic support and training within a high-volume pharmacy practice environment.

Highest-signal resume keywords

Doctor Of Pharmacy (PharmD.)Active Pharmacist LicensePrior Authorization ExperienceUtilization Management StrategiesClinical Guidelines

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Decision-MakingPrior Authorization ReviewsFormulary DesignDrug InformationUtilization Management

Soft Skills

Strong Communication SkillsOrganizational SkillsEmpathyAdaptabilityAbility To Manage Multiple Priorities

Tools & Technologies

Google WorkspaceGmailDocsSheetsDrive

Certifications & Qualifications

Pharmacist License

Industry Keywords

URAC StandardsNCQA StandardsHIPAA GuidelinesFraud, Waste, And Abuse (FWA)Managed Care

About the role

Key responsibilities & impact

Review and make timely, evidence-based decisions on prior authorizations and appeals using clinical guidelines and benefit criteria
Ensure compliance with federal, state, and internal regulations across applicable lines of business
Accurately document clinical decisions and maintain thorough records in accordance with URAC/NCQA utilization review standards
Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries
Stay current with clinical prescribing guidelines, internal policies, and regulatory changes
Follow internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security
Identify and report potential fraud, waste, and abuse (FWA)
Support training and development of new and existing team members
Assist leadership with special projects, process improvements, and operational initiatives

Requirements

What you’ll need

Doctor of Pharmacy (PharmD.) or Bachelor of Science in Pharmacy (B.S. Pharm) from an ACPE-accredited school of pharmacy
Active, unrestricted, pharmacist license in state of residence
Minimum of 2 years of pharmacy practice experience
Strong communication, writing, and organizational skills
Ability to manage multiple priorities in a high-volume, metric-driven environment
General understanding of drug information, clinical guidelines, formulary design, and utilization management strategies
Flexible and adaptable to changes
Availability to work after hours, weekends, and holidays on a rotating or fixed schedule
Preferred: One year of prior authorization or utilization management experience
Preferred: One year experience in managed care or pharmacy benefit management (PBM)
Preferred: Direct experience conducting prior authorization reviews, clinical appeals, formulary exceptions, step therapy evaluations, and quantity limit reviews
Preferred: Experience in Google Workspace (Gmail, Docs, Sheets, and Drive)

Benefits

Comp & perks

Bonuses, commissions, or equity may be available
Time off programs
Medical insurance
Dental insurance
Vision insurance
Mental health support
Paid parental leave
Life insurance
Disability insurance
401(k)