Director, Clinical Review

Summary

Join SmithRx, a rapidly growing Health-Tech company, as the Director of Clinical Review and lead the team in optimizing quality, efficiency, and productivity within clinical guidelines. Oversee clinical decision-making in drug management programs, provide clinical guidance and mentorship, and ensure customer satisfaction. Accountable for resolving cross-functional issues, collaborating with sales, and leading the evaluation of opportunities to improve pharmacy benefit drug management. You will also identify and execute process improvements, manage team performance through KPIs, and forecast staffing needs. This role requires a PharmD license, 10 years of professional experience (including 5+ years in a leadership role), and strong analytical and communication skills. Some travel may be required.

Requirements

• PharmD with current license in good standing in the relevant jurisdiction
• PharmD in co required
• 10 years of professional experience, including 5+ years in a people leadership or director role
• Ability to work independently as well as part of an extended, cross-functional team
• Conflict resolution skills
• Empathetic communicator with a consultative approach, able to see things from other person's point of view
• Robust analytical skills; advanced skills in Microsoft Excel
• Experience with excel and data analysis
• Strong communication skills via face-to-face meetings, conference calls and written correspondence
• Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges, and deliver on commitments
• Execution-focused ethos - you are a solutions-oriented problem solver and efficiency driven
• Flexible, adaptable, and able to respond under the pressure of a fast-paced technology company

Responsibilities

• Senior Leader of the Clinical Review team
• Oversight of clinical decision-making aspects of SmithRx’s drug management programs
• Provide clinical guidance to staff as needed
• Provide mentorship and career development for all level of employees of the team
• Accountable for customer satisfaction, including members, physicians, and clients, related to the review process
• Support and attend client-facing meetings as needed related to the clinical processes
• Work with internal leaders to resolve cross-functional issue resolution for client escalations
• Collaborate with the sales to information in support of RFP documents
• Leads evaluation and identification opportunities for improved management of pharmacy benefit drugs through clinical research and analytics that improve medical cost savings and provide clinical quality initiatives
• Identify and execute process improvements on an on-going basis with a focus on improving member experience, employee satisfaction, and employer cost
• Identify and evaluate tools and resources, such as technology, to drive workflow within the team
• Forecast and manage staffing, including but not limited to interview, hire, training, and budgets for the function
• Create and maintain a positive and collaborative team environment
• Monitor and manage team performance through KPI’s and data analytics
• Some travel may be required

Preferred Qualifications

PBM experience

Benefits

• 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
• 12 Paid Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities