Pharmacy Technician - Prior Authorization Specialist

Why MCR Health?

A career at MCR Health offers exciting opportunities with one of the largest Healthcare companies in the areas we serve. Now, more than ever, we are looking for exceptional people to support our passion to provide "Exceptional Care to Everyone, Every Time" and to support our Mission to serve everyone. Whether you provide direct patient care or in other areas of our Company, you can find a home here.

We invite you to be part of our company, where you can grow your career and serve with your heart.

In our time of Company growth, we are seeking a Pharmacy Technician - Prior Authorization Specialist.

Work Location:

Bradenton, FL

• Initiate, track, and complete prior authorization requests for prescription medications according to payer requirements and established workflows.
• Review patient profiles, insurance benefits, formulary restrictions, and coverage criteria.
• Collect and submit supporting clinical documentation from prescribers.
• Maintain accurate records of all prior authorization activity.
• Communicate with physicians, nurses, pharmacists, insurance representatives, and patients regarding authorization status.
• Follow up on pending authorizations to ensure timely determinations.
• Document all activities, communications, approvals, and denials in the appropriate systems.
• Assist with appeals, reconsiderations, and exception requests when necessary.
• Identify alternative formulary options and coverage solutions for pharmacists and providers.
• Maintain knowledge of payer policies, specialty medications, and utilization management requirements.
• Support quality improvement initiatives related to prior authorization turnaround times and approval rates.
• Ensure compliance with HIPAA, state pharmacy regulations, and organizational policies.
• Under the direction of the pharmacy manager and/or staff pharmacist, the pharmacy technician is responsible for assisting with delegated tasks related to the business of pharmacy in accordance with applicable regulatory statutes and accreditation standards; interpreting prescription orders; compounding, packaging, labeling, dispensing, and distribution of drugs and devices while covering shifts at a particular MCR Health pharmacy site
• The pharmacy technician will assist the Pharmacist by successfully operating the store location as defined in Florida DPR Statute #465.018, and other requirements as defined in Statutes 465, 21s, 893, plus applicable DEA requirements
• Delivers an exceptional pharmacy patient care experience to every patient every time.
• Performs other duties as assigned

• Registered Pharmacy Technician by the State of Florida required
• Working knowledge of 340b drugs according to OPA requirements required
• Knowledge of pharmacy claims processing, insurance benefits investigation, and medication prior authorization workflows required
• Working knowledge of pharmacy software system (DRX) and Electronic Health Record (Athena) preferred
• Working knowledge of Cover My Meds platform preferred
• Nationally Certified Pharmacy Technician preferred
• Microsoft Office Products – Word, Excel, Outlook, PowerPoint proficiency preferred

While under the direct supervision of the pharmacist, the prior authorization specialist will be responsible for supporting the medication prior authorization process by assist by coordinating with healthcare providers, insurance companies, pharmacies, and patients to obtain coverage approvals; completing all delegated tasks given by the pharmacy manager to execute the mission of MCR Health while abiding by the Florida Board of Pharmacy, DEA and MCRHS rules, regulations, policies and procedures.

This role ensures timely processing of authorization requests, minimizing delays in patient care, and maintaining compliance with payer and regulatory requirements. This position is appointed by the pharmacy manager to assist with operational functions and all training and program execution related to the department.

• MCR Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.