Senior Clinical Pharmacy Technician – Medi-Cal Rx

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

📋 Description

• Conduct thorough reviews, research, and resolution of prior authorization requests utilizing clinical criteria, established guidelines, and professional judgment.

• Communicate coverage decisions, formulary alternatives, and prior authorization requirements to providers and internal stakeholders.

• Handle incoming and outgoing inquiries regarding eligibility, benefits, claims, and prior authorizations.

• Escalate complex clinical cases or exceptions to a pharmacist with comprehensive documentation.

• Provide education to providers and members on claims submission, appeal requirements, and reimbursement guidelines.

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

• Identify trends, root causes, high-risk inquiries, and workflow deficiencies, and suggest process enhancements.

• Act as a resource for team members, addressing process inquiries and aiding in onboarding activities.

• Carry out other assigned duties as necessary.

⛳️ Requirements

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

• 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 requiring work visa or residency sponsorship.

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

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

• Excellent communication skills to guide and support team members effectively.

• Proficient in pharmacy systems and Microsoft Office applications.

• Preferred: 1 year of experience in reimbursement.

• Preferred: Experience in PBM or healthcare sectors.

• Must adhere to security responsibilities, as well as all relevant legal, regulatory, contractual requirements, and internal policies and procedures.

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

🏝️ Benefits

• Reasonable accommodations for employees with disabilities, barring undue hardship.

• Equal opportunity and affirmative action employer.

• Tobacco-Free Workplace.