Manager, Clinical Review and Quality Assurance

Are you passionate about making a real difference in healthcare, driving quality, and ensuring clinical excellence? Do you thrive in a leadership role, guiding processes and teams to achieve outstanding results? At SmithRx, we are not just another company; we are actively disrupting the traditionally complex Pharmacy Benefit Management (PBM) sector, building a next-generation platform designed for efficiency and superior customer service. We are looking for a dynamic and experienced leader to join our mission as Manager, Clinical Review and Quality Assurance. This is a chance to truly impact lives and shape the future of healthcare, all from a fully remote setting, open to talent worldwide.

Overview

SmithRx is a rapidly growing, venture-backed Health-Tech company dedicated to transforming the U.S. healthcare system. Our innovative drug acquisition platform, powered by cutting-edge technology and supported by best-in-class customer service, has already onboarded hundreds of thousands of members since 2016. We pride ourselves on a mission-driven and collaborative culture that empowers employees to do their best work. As the Manager, Clinical Review and Quality Assurance, you will be instrumental in upholding our commitment to patient safety and clinical integrity, ensuring every decision aligns with the highest ethical and professional standards within our growing organization.

Key Responsibilities

In this vital leadership position, you will be responsible for a range of critical functions, ensuring our clinical operations are both efficient and impeccably high quality. Some of your primary duties will include:

Leading and developing a high-performing team focused on clinical review and quality assurance, fostering a culture of continuous improvement and professional growth.
Overseeing and optimizing clinical review processes, including prior authorizations, drug utilization review, and appeals, ensuring compliance with established guidelines and regulatory requirements.
Developing, implementing, and maintaining robust quality assurance programs for all clinical operations to identify areas for improvement and ensure consistent service delivery.
Conducting regular audits and assessments of clinical decisions and documentation, providing constructive feedback and implementing corrective actions as needed.
Staying abreast of industry best practices, regulatory changes, and clinical guidelines to proactively adapt our processes and maintain compliance.
Collaborating cross-functionally with product, operations, and client services teams to integrate clinical insights and support overall business objectives.
Developing and delivering comprehensive training programs for clinical staff on new guidelines, procedures, and quality standards.
Analyzing clinical data and performance metrics to identify trends, report on quality indicators, and drive data-informed decision-making.

Requirements

To truly excel in this role, we are looking for someone with a proven track record and a deep understanding of the healthcare landscape. Ideal candidates will possess:

A Doctorate of Pharmacy (PharmD) or Registered Nurse (RN) license with an active, unrestricted status.
Significant experience, typically 5+ years, in a clinical review, quality assurance, or managed care setting, preferably within the Pharmacy Benefit Management (PBM) industry.
Demonstrated leadership experience, including managing, mentoring, and developing a team of clinical professionals.
A strong understanding of healthcare regulations, compliance standards, and accreditation requirements related to clinical services.
Exceptional analytical skills, with the ability to interpret complex data and translate insights into actionable quality improvements.
Outstanding communication and interpersonal skills, capable of engaging effectively with internal teams, external partners, and regulatory bodies.
A proactive approach to problem-solving and a commitment to continuous process optimization.
Proficiency with relevant clinical software and data management systems.

What You'll Gain

Joining SmithRx means more than just a job; it's an opportunity to grow, innovate, and truly make a difference. You will find:

The chance to make a tangible impact on the U.S. healthcare system, directly contributing to more affordable and accessible pharmacy benefits.
An environment that values integrity and courage, encouraging you to challenge the status quo and lead with ethical principles.
A collaborative and supportive culture where your contributions are recognized and celebrated.
Significant professional growth opportunities as you lead a critical function within a rapidly expanding health-tech company.
The flexibility and autonomy of a fully remote role, allowing you to balance your professional and personal life effectively.
Competitive compensation, comprehensive benefits, and a commitment to your overall well-being.