Senior Clinical Pharmacy Technician – Medi-Cal Rx

This is a fully remote position, open to applicants in California.

📋 Description

• Conduct independent reviews, research, and resolution of prior authorization requests utilizing clinical criteria, established guidelines, and professional judgment within set protocols.

• Convey coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders.

• Handle both inbound and outbound inquiries regarding eligibility, benefits, claims, and prior authorizations.

• Escalate clinically complex or exception-based cases to a pharmacist with comprehensive documentation and relevant case context.

• Provide education to providers and members about claims submission processes, appeals requirements, and reimbursement guidelines across various networks.

• Initiate, prioritize, and manage cases by accurately collecting and entering member and provider information.

• Identify trends, root causes, high-risk inquiries, and workflow gaps, proposing recommendations for process improvements.

• Act as a resource for team members by offering guidance, answering process-related questions, and aiding in onboarding activities.

• Carry out other assigned duties as necessary.

⛳️ Requirements

• High school diploma from an accredited institution or equivalent GED.

• A minimum of 2 years of experience as a pharmacy technician.

• Licensed Pharmacy Technician in compliance with California state regulations.

• Must be eligible to work in the United States without the need for a work visa or residency sponsorship.

• Strong understanding of pharmacy workflows, terminology, and reimbursement processes.

• Capacity to prioritize tasks and manage multiple assignments in a fast-paced environment.

• Excellent communication skills with the ability to guide and support team members.

• Proficient in pharmacy systems and Microsoft Office applications.

• Preferred: 1 year of experience in reimbursement.

• Preferred: Experience in PBM or healthcare settings.

• Compliance with job-specific security responsibilities, controls, legal, regulatory, contractual, and internal requirements is mandatory.

• Must be capable of performing the essential functions of the role.

🏝️ Benefits

• A range of benefits, incentives, and additional compensation options are available; the posting directs applicants to Prime’s Benefits Page for further details.

• Reasonable accommodations are provided for employees with disabilities.

• Commitment to equal opportunity and affirmative action in employment.

• A Tobacco-Free Workplace.