Manager, Clinical Review and Quality Assurance

About This Opportunity

We are representing a confidential health technology organization in their search for a Manager, Clinical Review and Quality Assurance. Our client is transforming pharmacy benefit management through innovative technology and clinical excellence. This is a remote opportunity based in the USA.

This pivotal leadership role oversees the integrity, efficiency, and clinical strategy of prior authorization operations. You will lead a multidisciplinary team integrating Quality Assurance oversight, technical system management, and medication policy execution. This position bridges business requirements and technical execution to ensure programs are safe, evidence-based, compliant, and operationally excellent.

Responsibilities

• Lead and mentor a high-performing team across Quality Assurance, medication policy, and business analysis functions
• Direct the prior authorization quality assurance program, overseeing interrater reliability audits and team performance reviews
• Manage PA platform strategy, technical enhancements, data governance, and clinical rule configuration
• 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
• Ensure regulatory compliance and clinical utilization review best practices across all operations

What We're Looking For

• Education: Doctor of Pharmacy (PharmD) required
• Licensure: Active, unrestricted Registered Pharmacist (RPh) license
• Experience: 10+ years in clinical pharmacy within Health Plan or PBM environments
• Technical Proficiency: 5+ years supporting PA platforms, including ePA standards (NCPDP) and rule configuration experience with platforms such as Banjo Health or 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
• Communication: Exceptional influencing and communication skills with a bias for action in fast-paced environments

How We Work With You

Candidates apply directly through Get A Job.ai. Our talent team conducts an initial screening to understand your qualifications and career goals. Qualified candidates are then presented to our client for consideration. Please do not contact the hiring organization directly—all communication flows through our recruitment process to ensure the best experience for everyone involved.

Pay

Compensation for this role varies by geographic zone and will be discussed during the screening process. Our client offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, parental leave, professional development opportunities, and additional wellness benefits.

Equal Employment Opportunity: Get A Job.ai is committed to providing equal employment opportunities to all applicants regardless of race, color, religion, sex, national origin, age, disability, or any other protected characteristic under applicable law.