Pharmacy Technician

Pharmacy Technician

The Pharmacy Technician supports multiple pharmacy operations areas, including formulary management, pharmacy audit and recovery, service center activities, Medicare Part D and B, appeals, and state health program pharmacy operations. Working within established guidelines, this role reviews prescription drug and pharmacy benefit requests submitted by physicians, medical groups, pharmacies, and members, and helps ensure accurate, timely, and compliant determinations. The Pharmacy Technician researches and resolves questions and issues, and collaborates closely with clinical pharmacists and medical leadership when needed.

• Review prior authorization requests for prescription drugs and pharmacy benefits submitted by physicians, medical groups, pharmacies, and members in accordance with established guidelines and criteria.
• Perform Intake activities by accurately typing all information from prior authorization request forms into the Compass case management system.
• Conduct Technician Review by verifying the accuracy of intake data and comparing the prior authorization request and clinical documentation against the appropriate clinical criteria.
• Determine whether requests can be approved based on established criteria and available clinical information.
• Identify missing or incomplete information and contact provider offices to obtain the documentation needed to complete the review.
• Route cases requiring denial decisions to the pharmacist queue for additional review and confirmation.
• Remediate cases that require overturning a determination or correcting an error, ensuring all updates are accurately documented in the system.
• Move completed cases to the Manual Outreach queue and contact providers and/or members by phone or fax to communicate final decisions.
• Research and resolve questions, problems, or issues related to prescription drug coverage and pharmacy benefits in a timely and professional manner.
• Consult with Clinical Pharmacists or Regional Medical Directors on complex or unclear cases requiring clinical judgment.
• Maintain a high level of accuracy and attention to detail in data entry, documentation, and case processing.
• Use collaboration tools such as Teams and Outlook to communicate with team members, participate in meetings, and maintain strong connectivity in a remote environment.

• Active pharmacy technician license, with the ability to perform technician duties in accordance with applicable regulations.
• Minimum of 2 years of experience as a Pharmacy Technician.
• Experience working in pharmacy settings such as retail, managed care, or similar environments involving claims and prior authorizations.
• Proficiency in accurate and efficient data entry.
• Ability to interpret and apply established formulary, coverage, and prior authorization criteria.
• Strong attention to detail and accuracy when reviewing clinical documentation and case information.
• Effective verbal and written communication skills for interacting with provider offices, members, and internal clinical staff.
• Proficiency with Microsoft Teams, Outlook, Word, Excel, and One Note.
• Ability to work effectively in a structured, guideline-driven environment and follow standardized processes.
• Capability to work independently in a remote setting while remaining engaged and responsive to team communication.

• Customer service or retail experience, particularly in pharmacy or healthcare settings, is preferred.
• Experience in managed care pharmacy, including exposure to claims processing or prior authorization workflows, is beneficial.
• Comfort working with multiple technology platforms and case management systems such as Compass or similar tools.
• Strong organizational skills and the ability to manage workload and priorities within defined time frames.
• Ability to collaborate with pharmacists and clinical leadership on complex cases and follow through on remediation tasks.

This is a fully remote role that operates within a highly connected and collaborative virtual team. Most daily interaction with colleagues takes place through Microsoft Teams using chat, audio or video calls,…