Senior Clinical Review Operations Pharmacist

SmithRx

. Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency.

Posted 10/15/2026full-timeRemote • United StatesSenior💰 $144,500 - $204,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical operations and prior authorization review, with a strong focus on process improvement and technology adoption. Capable of providing clinical guidance and support while effectively managing complex cases and collaborating with internal teams.

Highest-signal resume keywords

5+ Years Health Plan ExperienceActive Pharmacist LicenseBachelor’s Degree in Pharmacy or PharmDClinical Subject Matter ExpertProcess Improvement Expertise

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ReviewClinical OperationsDrug Product/Dose CalculationsClaims Adjudication RulesPharmacy Dispensing Processes

Soft Skills

Active ListeningCommunication SkillsMultitaskingTime ManagementProblem-Solving Abilities

Tools & Technologies

MacMS OfficeG-Suite

Certifications & Qualifications

Active Pharmacist License

Industry Keywords

Pharmacy Benefit Manager (PBM)Clinical ReviewWorkflow EfficiencyClinical GuidelinesOperational Technology

About the role

Key responsibilities & impact

Identify operational process gaps and champion technology-driven solutions to improve throughput, scalability, and workflow efficiency.
Provide clinical guidance, coaching, and onboarding support to fellow pharmacists.
Act as a senior operational contact for complex clinical cases, escalated coverage determinations, and appeals.
Partner with internal teams to troubleshoot eligibility questions, claims adjudication, and benefit design nuances.
Collaborate with clinical leadership and the Pharmacy and Therapeutics Committee to develop, refine, and review clinical criteria for medications requiring prior authorization.
Meet or exceed individual target KPIs and turnaround-time SLAs.
Drive adoption of new technology, workflow tools, and updated clinical protocols across the Clinical Review team.

Requirements

What you’ll need

5+ years of health plan or Pharmacy Benefit Manager (PBM) experience, specifically involved in prior authorization review and clinical operations.
Demonstrated expertise as a clinical subject matter expert with a track record of driving process improvements or technology-driven efficiencies.
Active Pharmacist License (unrestricted) required.
Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
Strong proficiency with Mac, MS Office, and G-Suite platforms.
Excellent active listening and communication skills to convey complex clinical information.
Superior multitasking, time management, and problem-solving abilities.
Deep understanding of drug product/dose calculations, claim adjudication rules, and general pharmacy dispensing processes.
Adaptability to evolving clinical guidelines, changing protocols, and new operational technology.

Benefits

Comp & perks

Medical, Pharmacy, Dental, Vision, and Life Insurance
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
Time off programs
Mental health support
Bonuses, commissions, or equity may be available