Job Title: Pharmacy Technician

Job Description

We are seeking dedicated pharmacy technicians to review Prior Authorizations for coverage determination within a Pharmacy Services department. This role is part of a large healthcare insurance company and involves approving or denying requests before forwarding them for final review by a pharmacist. The position primarily involves handling health plans and various medications with minimal phone work, mostly outbound.

Responsibilities

• Track coverage determination requests and obtain verbal authorizations.
• Approve requests based on criteria and enter decisions into the PBM system.
• Notify providers and members of outcomes and refer requests for specialty drugs.
• Respond to client inquiries and contact providers for additional information.
• Notify stakeholders of decision outcomes and obtain detailed clinical information from prescribers.
• Assist with inbound and/or outbound patient or physician calls, if necessary.

Essential Skills

• Registered pharmacy technician in the state of residence.
• Nationally certified pharmacy technician.
• Strong computer skills and proficiency with Microsoft Office.
• Experience with prior authorization processes.
• High School diploma or GED.

Additional Skills & Qualifications

• Certification through PTCB or NHA.
• Experience in retail pharmacy, hospital, or specialty pharmacy settings.
• Familiarity with Medicare and Medicaid.

Work Environment

The role is conducted in a professional remote environment, requiring the use of multiple screens and systems. A strong Wi-Fi connection and a private office space with a closed door are essential. Work hours are Monday-Friday, 8am-8pm in the local timezone, with rotating weekends every 4-6 weeks and some holidays. Training is scheduled from 10am to 6:30pm EST, after which regular shifts will be assigned. Equipment including a computer, monitor, and headset will be provided, and schedules are sent three months in advance. Flexibility may be offered to employees who have earned it through hitting metrics and tenure.