This role is STARs-friendly: Skilled Through Alternative Routes.
73% STARs in role.
This remote Pharmacy Technician role focuses on reviewing prior authorization requests and making coverage determinations for a pharmacy services department within a large health insurance organization. You will evaluate requests for a wide range of medications across multiple health plans, approve or deny based on established criteria, and route decisions to a pharmacist for final review. The position offers long-term career potential, the opportunity to convert to a permanent role with benefits and paid time off, and the chance to work in a professional, technology-driven environment.
Responsibilities- Review prior authorization requests for prescription medications across multiple health plans and determine coverage based on established clinical and plan criteria.
- Approve or deny coverage determinations and forward all decisions to a pharmacist for final review and sign-off.
- Track coverage determination requests from receipt through final decision, ensuring timely and accurate processing.
- Enter all decisions and relevant information into the pharmacy benefit management (PBM) system and other internal platforms with a high level of accuracy.
- Notify providers and members of coverage decisions in accordance with departmental procedures and regulatory requirements.
- Obtain verbal authorizations from prescribers and other authorized parties when required.
- Request and collect detailed clinical information from prescribers to support coverage determination decisions.
- Respond to client and provider inquiries regarding prior authorization status, criteria, and outcomes, escalating as needed.
- Refer requests for specialty medications or complex therapies to the appropriate specialty or clinical teams.
- Contact providers and other stakeholders to clarify prescriptions, gather missing information, or resolve discrepancies related to coverage requests.
- Notify all relevant stakeholders, including providers and members, of decision outcomes and any next steps or appeals processes, as applicable.
- Assist with inbound and outbound patient or physician calls on an as-needed basis, while maintaining a focus on prior authorization processing.
- Handle minimal phone work, primarily outbound calls, to obtain information or provide updates related to coverage determinations.
- Work efficiently within multiple computer systems and screens to manage requests, document actions, and maintain accurate records.
- Meet performance metrics and quality standards for accuracy, turnaround time, and customer service to qualify for schedule flexibility and advancement opportunities.
- Current registration as a pharmacy technician in the state of residence, in good standing, as required by state regulations.
- National pharmacy technician certification (such as PTCB or NHA) and Certified Pharmacy Technician credentials, as required.
- High school diploma or GED.
- Strong computer skills, including proficiency with basic computer operations and navigating multiple systems and screens.
- Proficiency with Microsoft Office applications, including Outlook, for communication and documentation.
- Demonstrated ability to perform accurate and efficient data entry.
- Experience as a pharmacy technician in environments such as retail pharmacy, hospital pharmacy, PBM, call center, or specialty pharmacy.
- Knowledge of prior authorization processes and prescription benefit coverage.
- Familiarity with Medicare, Medicaid, and prescription benefit structures.
- Strong customer service skills, including clear communication with providers, members, and internal teams.
- Ability to work remotely in the EST time zone and maintain productivity in a professional home office setting.
- Reliable high-speed internet (Wi-Fi) and the ability to use a smartphone for work-related communication and authentication.
- Registered Pharmacy Technician and Certified Pharmacy Technician credentials recognized by relevant state boards and national certifying bodies.
- Experience working in a pharmacy benefit management (PBM) environment or with prescription benefit programs.
- Background in retail pharmacy, hospital pharmacy, or specialty pharmacy settings.
- Prior experience handling prior authorizations and coverage determinations for various drug types and health plans.
- Comfort working with multiple screens and complex software systems simultaneously.
- Strong attention to detail and accuracy when reviewing clinical information and entering data.
- Ability to manage a high volume of requests while maintaining quality and compliance.
- Experience in a call center or customer support environment, especially in healthcare or pharmacy services.
- Demonstrated reliability and performance that can lead to schedule flexibility and long-term career growth.
This is a fully remote position based in a professional home-office setting, aligned with the Eastern Standard Time zone. You will work with multiple computer screens and within several pharmacy and PBM systems to process prior authorizations and coverage determinations. The company provides equipment, including a computer, monitor, and headset; you must supply reliable high-speed Wi-Fi, a dedicated workspace with a door that can be closed for privacy, and a smartphone. Standard operating hours are Monday through Friday, 8:00 a.m. to 8:00 p.m. in your local time zone, and you must be available within that window. The role includes rotating weekend shifts approximately every 4–6 weeks and requires the ability to work some holidays, with holiday schedules assigned through a bidding process. Training runs from 10:00 a.m. to 6:30 p.m. EST, after which you will transition to your regular schedule. Schedules are published approximately three months in advance. The environment emphasizes professional conduct, consistent performance, and the use of modern technology, with the potential for added flexibility as you meet performance metrics and gain tenure.
Job Type & LocationThis is a Contract to Hire position based out of Dallas, TX.
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 1, 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-006228823