Remote Certified Pharmacy Technician

Job Title:

Remote Pharmacy Technician - Prior Authorization

Job Description

This remote Pharmacy Technician role focuses on reviewing prior authorization requests and making coverage determinations for a pharmacy services department within a large healthcare insurance organization. You will evaluate requests for all health plans and medication types, document decisions in pharmacy benefit management systems, and collaborate closely with pharmacists and healthcare providers. The position offers minimal phone work, long-term career potential, and the opportunity to transition to a permanent role with benefits.

Responsibilities

+ Review prior authorization requests for prescription medications across multiple health plans and drug types.

+ Evaluate coverage determination requests using established clinical and benefit criteria.

+ Approve or deny requests based on defined guidelines and route all decisions to a pharmacist for final review.

+ Track coverage determination requests from receipt through final decision and documentation.

+ Enter all decisions, notes, and supporting information accurately into the pharmacy benefit management (PBM) system.

+ Notify providers and members of coverage determination outcomes in a timely and professional manner.

+ Obtain verbal authorizations from prescribers or their offices when required.

+ Request and collect detailed clinical information from prescribers to support coverage decisions.

+ Respond to client and internal inquiries related to prior authorization status, criteria, and outcomes.

+ Refer requests involving specialty medications or complex therapies to the appropriate specialty team or pharmacist.

+ Contact providers to clarify prescriptions, gather additional information, or resolve discrepancies in requests.

+ Notify all relevant stakeholders, including providers and members, of final decision outcomes and any next steps.

+ Assist with inbound and outbound patient or physician calls as needed, with an emphasis on outbound calls.

+ Use multiple computer systems and applications simultaneously to research, document, and process requests.

+ Maintain accurate, detailed records and ensure data entry meets quality and compliance standards.

+ Follow all regulatory, organizational, and departmental policies and procedures related to pharmacy services.

+ Meet or exceed productivity, quality, and timeliness metrics established by the department.

+ Participate in training and ongoing education to stay current with policies, systems, and coverage criteria.

+ Collaborate with pharmacists and team members to resolve complex cases and ensure consistent decision-making.

+ Provide professional, courteous customer service in all interactions with members, providers, and colleagues.

Essential Skills

+ High school diploma or GED.

+ Current pharmacy technician registration in the state of residence.

+ National pharmacy technician certification (such as PTCB or NHA).

+ Registered Pharmacy Technician and Certified Pharmacy Technician credentials, as required by state regulations.

+ Experience as a pharmacy technician in retail, hospital, PBM, call center, or specialty pharmacy settings.

+ Demonstrated experience with prior authorization processes and coverage determinations.

+ Strong computer skills, including the ability to work efficiently in multiple systems and on multiple screens.

+ Basic to intermediate proficiency with Microsoft Office, including Outlook.

+ Accurate and efficient data entry skills with strong attention to detail.

+ Ability to handle prescription benefits and understand pharmacy benefit structures.

+ Customer service experience in a healthcare, pharmacy, or call center environment.

+ Ability to work independently in a remote setting and manage time effectively.

+ Reliable high-speed internet (Wi-Fi) and the ability to maintain connectivity during working hours.

+ Ability to work Monday through Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, with rotating weekend availability.

+ Ability to work some holidays as part of a scheduled rotation.

Additional

Skills & Qualifications

+ Experience working with Medicare and Medicaid prescription benefits.

+ Prior experience in a pharmacy benefit manager (PBM) environment.

+ Experience in specialty pharmacy or handling specialty medications.

+ Experience in retail pharmacy, hospital pharmacy, or specialty pharmacy settings.

+ Strong written and verbal communication skills for interacting with providers, members, and internal teams.

+ Ability to adapt to new systems and processes quickly.

+ Comfort working in a metrics-driven environment with performance expectations.

+ Interest in long-term career growth within a large healthcare organization.

+ Motivation to transition from contract to permanent employment, including eligibility for benefits and paid time off.

+ Professionalism and discretion when working with confidential health information.

Work Environment

This is a fully remote position based in the Eastern Time Zone, supporting a large, nationwide…