临床审查与质量保证经理
Manager, Clinical Review and Quality Assurance
我们是谁：
SmithRx 是一家快速发展的、获得风险投资支持的医疗科技公司。我们的使命是通过构建由前沿技术、创新的节省成本工具和一流的客户服务驱动的下一代药品采购平台，颠覆昂贵且低效的药房福利管理（PBM）行业。自2016年以来，已有数十万成员加入，SmithRx 的解决方案正在全国各地的客户中产生共鸣。
我们以使命驱动和协作文化为荣，这种文化激励员工发挥最佳水平。我们认为美国医疗体系需要变革，我们每天都在致力于实现这一改变。我们核心的价值观包括：
- 正直：我们的目标指引我们的行动，并让我们对前方的道路充满信心。我们以坚定不移的诚实和可靠，面对挑战，展现道德领导力，创造新的可能。
- 勇气：我们以坚韧和韧性面对持续的挑战。我们通过在自主性和同理心之间取得平衡，在责任感与脆弱性之间取得平衡，来拥抱未知的不适。我们大胆挑战现状，不断前进——永不停歇。
- 一起：SmithRx 的成功反映了我们合作伙伴的力量和团队的承诺。我们的共同价值观将我们联系在一起，使我们成为一个整体。当一个人跌倒时，我们所有人都会跌倒；当一个人崛起时，我们所有人都会崛起。
职位概述：
SmithRx 正在寻找一位有活力且经验丰富的领导者，担任临床审核运营与质量保证经理。这个关键角色负责我们事先授权（PA）生态系统的完整性、效率和临床策略。您将领导一个跨职能团队，整合质量保证（QA）监督、技术系统管理和药物政策执行。您将在业务需求和技术执行之间架起桥梁，确保我们的 PA 项目安全、基于证据、合规且运营卓越。
您将负责：
- 团队领导：指导并统一 QA、药物政策和业务分析领域的高绩效团队，推动组织目标。
- 质量保证：主导 PA 质量保证计划，监督评审者间一致性审计并审查团队表现。
- 平台管理：领导 PA 平台战略、技术改进、数据治理和临床规则配置
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Who We Are:
SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.
We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:
- Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
- Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
- Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.
Job Summary:
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.
What SmithRx Offers You:
- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and 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
Zone A includes the following locations:
- San Francisco Bay Area - California
- Metro New York City - Connecticut, New Jersey, New York and Pennsylvania
Zone A Pay Range
$163,200—$192,000 USD
Zone B includes the following locations:
- California - outside of San Francisco Bay Area
- Metro Denver / Boulder - Colorado
- Metro District of Columbia - District of Columbia, Maryland, Virginia and West Virginia
- Metro Boston / Cambridge - Massachusetts and New Hampshire
- Metro Austin - Texas
- Metro Seattle - Washington
Zone B Pay Range
$149,600—$176,000 USD
Zone C includes all other locations not listed above, including:
- Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Wisconsin, Wyoming
- Non metro Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Virginia, Washington, and West Virginia
Zone C Pay Range
$136,000—$160,000 USD
Compensation & Benefits
- Base Salary: The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.
- Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity. SmithRx offers a variety of benefits to help you live well, including: time off programs, medical, dental, vision, mental health support, paid parental leave, life and disability insurance and 401(k).
Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process. In the meantime, feel free to explore our comprehensive benefits here.