Lead Clinical Review Pharmacist (Healthtech)

TL;DR

Lead Clinical Review Pharmacist (Healthtech): Managing and coaching a team of Prior Authorization Pharmacists to ensure high-quality reviews and regulatory compliance with an accent on operational performance and member experience. Focus on driving team KPIs, optimizing clinical review processes, and ensuring adherence to US healthcare regulatory standards.

Location: Remote (Must be based in the USA)

Company

hirify.global is a venture-backed Health-Tech company disrupting the Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform.

What you will do

• Directly manage, coach, and mentor a team of prior authorization Pharmacists.
• Ensure adherence to regulatory, compliance, and accreditation standards (URAC, NCQA).
• Recruit, hire, and lead the onboarding and training of new team members.
• Drive team performance through the measurement and management of key performance indicators (KPIs).
• Identify and implement operational process improvements to support business scaling.
• Collaborate cross-functionally on benefit designs, claims adjudication, and clinical criteria development.

Requirements

• Active Pharmacist License and Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
• Must be based in the US (indicated by 401k and US-specific regulatory requirements).
• 5+ years of health plan or PBM experience specifically in prior authorization review.
• 3-5+ years of management experience.
• Familiarity with ERISA, ACA, Medicare, URAC, and NCQA requirements.
• Proficiency in Mac, MS Office, and G-Suite.

Culture & Benefits

• Comprehensive wellness package including Medical, Pharmacy, Dental, Vision, and Life Insurance.
• 401(k) Retirement Savings Program and Flexible Spending Benefits.
• Discretionary Paid Time Off and Paid Company Holidays.
• Paid Parental Leave and Employee Assistance Program (EAP).
• Professional development and training opportunities.