Manager, Clinical Review Operations and Quality Assurance

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.