This role is STARs-friendly: Skilled Through Alternative Routes.
73% STARs in role.
Job Title: Remote Pharmacy Technician – Prior Authorization Review
Job Description
This remote Pharmacy Technician role focuses on reviewing pharmacy prior authorization requests for a large health insurance pharmacy services department. You evaluate coverage determinations for a wide range of health plans and medications, approve or deny requests based on established criteria, and route them to pharmacists for final review. The position involves detailed computer-based work in a professional virtual environment, with minimal phone interaction and the opportunity to grow into a long-term, permanent role with benefits.
Responsibilities
- Review pharmacy prior authorization requests for coverage determination across multiple health plans and medication types.
- Evaluate requests against established criteria and either approve or deny them prior to pharmacist review.
- Enter coverage decisions accurately into the Pharmacy Benefit Management (PBM) system and other internal platforms.
- Track coverage determination requests from receipt through final decision and documentation.
- Obtain verbal authorizations from prescribers and request detailed clinical information when needed to support decision-making.
- Notify providers, members, and other stakeholders of coverage decisions in a clear and timely manner.
- Respond to client and provider inquiries related to prescription benefits, prior authorizations, and coverage determinations.
- Refer requests for specialty medications or complex cases to appropriate internal teams or pharmacists.
- Contact providers for additional clinical or administrative information required to complete prior authorization reviews.
- Assist with inbound and outbound patient or physician calls as needed, with a focus on outbound communication.
- Handle Medicare and Medicaid prescription benefit inquiries in accordance with applicable guidelines and policies.
- Use multiple computer systems and screens simultaneously to review requests, document decisions, and update records.
- Maintain high standards of accuracy, data entry quality, and confidentiality in all documentation and communications.
- Meet performance metrics related to productivity, quality, and turnaround time for prior authorization reviews.
- Collaborate with pharmacists and other team members to ensure consistent application of coverage criteria and processes.
- Provide professional customer service to members, prescribers, and internal stakeholders in a call center–style environment when required.
Essential Skills
- High school diploma or GED.
- Current registration as a pharmacy technician in the state of residence, in good standing.
- National pharmacy technician certification (such as PTCB or NHA).
- Active Pharmacy Technician Certification (e.g., Certified Pharmacy Technician, CPhT).
- Pharmacy technician license and registration as required by the state of operation.
- Experience as a pharmacy technician in retail, hospital, PBM, call center, or specialty pharmacy settings.
- Proficiency in prior authorization processes and prescription benefits review.
- Strong computer skills, including working with multiple screens and systems simultaneously.
- Basic to advanced skills in Microsoft Office applications, including Outlook.
- Accurate and efficient data entry skills with attention to detail.
- Customer service experience in a healthcare, pharmacy, or call center environment.
- Ability to work remotely with reliable high-speed Wi-Fi and a dedicated workspace.
- Ability to work Monday–Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, with rotating weekend and some holiday coverage.
Additional Skills & Qualifications
- Experience working with Pharmacy Benefit Management (PBM) systems.
- Background in Medicare and Medicaid prescription benefits.
- Prior experience in retail pharmacy, hospital pharmacy, or specialty pharmacy.
- Familiarity with call center operations and workflows in a healthcare or insurance setting.
- Strong written and verbal communication skills for interacting with prescribers, members, and internal teams.
- Ability to interpret and apply coverage criteria and clinical information to authorization decisions.
- Comfort working with multiple technology platforms and electronic documentation tools.
- Ability to meet and maintain performance metrics, quality standards, and productivity goals.
- Interest in long-term career growth within a large, nationwide healthcare organization.
- Motivation to earn flexibility in scheduling through strong performance and tenure.
Work Environment
This position operates in a professional remote work environment within the Eastern Time Zone. Pharmacy technicians work primarily on computers, using multiple screens and systems to review prior authorization requests and enter decisions. The role involves minimal phone work, with most calls being outbound and occasional inbound patient or physician calls as needed. You must have reliable high-speed Wi-Fi, a private home office space with a door that can be closed, and a smartphone. The organization provides essential equipment, including a computer, monitor, and headset. Training is conducted from 10:00 a.m. to 6:30 p.m. Eastern Time, after which you transition to a regular schedule. You must be available Monday through Friday between 8:00 a.m. and 8:00 p.m. in your local time zone, with rotating weekend shifts approximately every 4–6 weeks and some holiday coverage. Holiday schedules are bid in advance, and regular schedules are provided three months ahead. The environment emphasizes professional conduct, strong performance, and offers increasing flexibility for team members who consistently meet metrics and demonstrate tenure, along with the potential to transition to a permanent role with benefits and paid time off.
Job Type & LocationThis is a Contract to Hire position based out of Providence, RI.
Pay and BenefitsThe pay range for this position is $20.00 - $23.00/hr.
Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace TypeThis is a fully remote position.
Application DeadlineThis position is anticipated to close on Sep 2, 2026.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
Posting ID: JP-006233209