Pharmacy Technician – Seasonal

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

📋 Description

• Provide assistance to members, providers, pharmacies, and internal SmithRx teams regarding prescription intricacies and ensure timely coverage of clinically suitable, cost-effective medication therapies.

• Coordinate clinical review cases and verify coverage and plan regulations.

• Confirm the accuracy of submitted information and perform outreach to pharmacies and providers.

• Assess prior authorization requests in accordance with established protocols.

• Triage and resolve questions and escalations.

• Verify eligibility and medication coverage to ascertain suitable claims processing.

• Manage clinical review for prior authorization requests across various levels.

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

• Organize and prioritize requests for efficient prior authorization case management.

• Create and modify authorizations within the claims adjudication system.

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

• Facilitate outreach across teams and assist in guiding processes and protocols.

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

• Identify when medications necessitate internal or external review.

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

⛳️ Requirements

• High School diploma or GED or equivalent professional experience.

• An active Pharmacy Technician license is mandatory.

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

• Experience in prior authorization review, particularly on the approval side at a PBM or health plan, is preferred.

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

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

• Excellent active listening and conversational speaking skills, demonstrating a high level of empathy.

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

• Ability to communicate clearly and convey complex information to members, clients, pharmacies, providers, and internal teams.

• Competence in adhering to protocols and following appropriate escalation pathways accurately.

🏝️ 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.