Pharmacy Technician – Seasonal

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

📋 Description

• Confirm eligibility and drug coverage based on plan benefit designs to ensure proper claims processing.

• Manage clinical review processes for prior authorization requests in accordance with established guidelines.

• Analyze prior authorization and similar requests utilizing criteria, claims history, and plan benefit regulations.

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

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

• Construct and modify authorizations within the claims adjudication system.

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

• Evaluate and integrate various workflows to make informed clinical decisions.

• Coordinate outreach between teams and address inquiries and escalations.

• Assess member clinical situations against medication policies and either approve or escalate cases to a Pharmacist for denial.

• Identify when medications necessitate internal or external review.

• Reach out to designated external stakeholders for approval on drugs subject to dollar limits.

⛳️ Requirements

• High School diploma, GED, or equivalent work experience is required.

• An active Pharmacy Technician license is mandatory.

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

• Experience with prior authorization review in a PBM or health plan is preferred.

• Proficiency in Mac, MS Office, and G-Suite is essential.

• Critical thinking skills are necessary to navigate complex customized benefit plans.

• Active listening and conversational speaking abilities, coupled with a high degree of empathy.

• Capacity to multitask, prioritize, and manage time efficiently.

• Ability to communicate effectively and present complex information to members, clients, pharmacies, providers, and internal teams.

• Ability to operate accurately within protocols and adhere to appropriate escalation procedures.

🏝️ Benefits

• Potential bonuses, commissions, or equity may be available.

• Time off programs.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Mental health support.

• Paid parental leave.

• Life insurance.

• Disability insurance.

• 401(k).