Pharmacy Technician – Seasonal

This is a fully remote position, open to applicants in Arizona, +9 more states.

📋 Description

• Support members, providers, pharmacies, and internal teams with the complexities of prescriptions and ensure timely access to clinically appropriate, cost-effective medication therapies.

• Confirm eligibility and medication coverage under plan benefit designs for claims processing.

• Manage clinical review and prior authorization requests following established protocols.

• Assess prior authorization requests based on criteria, claims history, and plan benefit regulations.

• Engage with prescribers and pharmacies to verify and collect necessary information.

• Organize and prioritize requests to ensure timely management of prior authorization cases.

• Create and modify authorizations within the claims adjudication system.

• Navigate various drug products and formulations while performing basic calculations to ensure accurate claims adjudication.

• Coordinate outreach efforts, address inquiries and escalations, and assist in guiding processes and protocols.

• Analyze clinical situations against medication policies and either approve or refer cases to a Pharmacist for denial.

• Identify when medications necessitate internal or external reviews.

• Reach out to selected external stakeholders for approval on medications with financial limits.

⛳️ Requirements

• High School diploma or GED or equivalent relevant work experience.

• Active Pharmacy Technician license is mandatory.

• 2-4 years of experience as a Pharmacy Technician.

• Preferred: 2+ years of experience in prior authorization reviews at a PBM or health plan.

• Required: Proficiency in Mac, MS Office, and G-Suite.

• Strong critical thinking skills to navigate complex customized benefit plans and make informed clinical decisions.

• Excellent active listening and conversational speaking abilities, coupled with a high level of empathy.

• Ability to multitask, prioritize effectively, and manage time efficiently.

• Strong communication skills to present complex information clearly to members, clients, pharmacies, providers, and internal teams.

• Capability to work accurately within protocols and adhere to appropriate escalation pathways.

🏝️ Benefits

• Time off programs.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Mental health support.

• Paid parental leave.

• Life insurance.

• Disability insurance.

• 401(k).

• Potential eligibility for bonuses, commissions, or equity.