Job Description
Job Summary: Prior Authorization Pharmacy Technician Role Overview: Join a leading pharmacy benefit management organization as a Prior Authorization Pharmacy Technician, supporting healthcare providers and members nationwide. In this fully remote, contract position, you will review and process prior authorization requests for prescription medications, ensuring timely and accurate determinations that impact patient access to critical therapies. This role demands strong clinical judgment within a PBM, managed care, or health plan environment, and offers a top-of-market pay rate with flexible scheduling options.
Key Responsibilities: - Review and process prior authorization requests for medications, including specialty and high-cost drugs, from providers, members, and pharmacies.
- Apply clinical criteria and analyze member claims history to determine approval or escalation of requests.
- Make outbound calls to providers and pharmacies to collect required documentation or clarify information.
- Submit completed authorizations to claims processors and support appeals as assigned.
- Escalate complex cases to pharmacists and direct members to appropriate clinical programs or in-network providers.
- Handle inbound prior authorization calls transferred from the customer care center.
- Meet productivity and quality standards while navigating multiple systems.
- Maintain compliance with all regulatory and client-specific requirements.
Skills Required: - Pharmacy prior authorization
- Clinical criteria application
- Claims review
- Specialty medications knowledge
- PTCB or NHA certification
- Typing proficiency (35 WPM minimum)
- Managed care experience
Recruiter Insights: -
Competitive Pay: $29/hr is well above typical remote PBM tech rates.
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Fully Remote: No geographic restrictions; select from three Eastern-based shifts.
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Immediate Impact: Backfill for a critical, high-volume desk prior experience is essential.
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Term & Transition: 3-month contract aligns with the client's transition to Optum Rx in January 2027; extension possible but limited.
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Preferred Skills: Appeals, coverage determination, specialty pharmacy, home infusion, LTC experience are a plus but not mandatory.
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Fast Fill: Submit only candidates with documented prior authorization experience retail-only techs are not a fit.
Candidate Insights: -
Top Pay: Earn at the upper end of the market for remote pharmacy technician roles.
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Flexible Scheduling: Choose from multiple shifts; weekend and holiday availability required.
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Work from Anywhere: Full remote flexibility within the US.
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Resume Standout: Prior PBM or managed care experience highly valued; opportunity to leverage and expand clinical and administrative skillsets.
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Short-Term Commitment: 3-month assignment with the possibility of extension, ideal for those seeking immediate impact or between long-term roles.
Make a difference in patient care while advancing your pharmacy technician career in a dynamic, remote environment. Apply your clinical and administrative expertise in a high-demand, high-reward role.
Job Tags
Contract work, Temporary work, Immediate start, Remote work, Flexible hours, Shift work, Weekend work