Manager, Clinical Review and Quality Assurance
New
S
SmithRxHealth-Tech
Location: RemoteFull-TimeManager
SalaryZone A: $163,200 - $192,000 USD; Zone B: $149,600 - $176,000 USD; Zone C: $136,000 - $160,000 USD
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Job Details
- Experience
- 10+ years in clinical pharmacy
- Required Skills
- Quality Assurance
Requirements
- Doctor of Pharmacy (PharmD) degree.
- Active, unrestricted Registered Pharmacist (RPh) license.
- 10+ years in clinical pharmacy, specifically within Health Plan or PBM environments.
- 5+ years supporting prior authorization (PA) platforms.
- Experience with ePA standards (NCPDP).
- Experience with rule configuration (e.g., Banjo Health, MHK).
- Strong background in QA best practices, clinical utilization review, and P&T committee support.
- Regulatory compliance experience.
- Proven ability to translate complex data and business requirements into actionable system changes.
- Exceptional communication and influencing skills.
Responsibilities
- Mentor and unify a high-performing team across QA, medication policy, and business analysis to drive organizational goals.
- Direct the PA quality assurance program, overseeing interrater reliability audits and reviewing team performance.
- Lead PA platform strategy, technical enhancements, data governance, and clinical rule configuration for optimal efficiency.
- Provide pharmacotherapy expertise for P&T Committee activities, formulary management, and evidence-based medication policy development.
- Drive technology enhancements and monitor key performance metrics using data-driven insights.
- Facilitate process documentation, lead User Acceptance Testing (UAT), and manage stakeholder training for system releases.
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