Remote Pharmacy Technician

Job Title:

Remote Pharmacy Technician

Job Description

This remote Pharmacy Technician position focuses on reviewing pharmacy prior authorization requests and supporting coverage determinations for a large healthcare insurance organization. You will evaluate requests for a wide range of medications and health plans, approve or deny based on established criteria, and route decisions to a pharmacist for final review. The role offers minimal phone work, long-term career potential, and the opportunity to transition to a permanent position with benefits in a professional, nationwide healthcare environment.

Responsibilities

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

* Evaluate coverage determination requests using established clinical and plan criteria and document clear approval or denial decisions.

* Enter all decisions and related information accurately into the pharmacy benefit management (PBM) system.

* Route completed coverage determinations to a pharmacist for final review and sign-off.

* Track and monitor coverage determination requests from receipt through final decision to ensure timely processing.

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

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

* Notify providers and members of decision outcomes in a clear and timely manner.

* Respond to client and provider inquiries related to prior authorization requests and prescription benefit coverage.

* Refer requests involving specialty medications or complex therapies to the appropriate specialty pharmacy or internal team.

* Contact providers or their staff to clarify information or obtain missing documentation needed for coverage determination.

* Assist with inbound and outbound patient or physician calls as needed, while maintaining a primarily non-phone-based workload.

* Use multiple computer systems and screens simultaneously to research, process, and document prior authorization cases.

* Maintain accurate, thorough, and compliant documentation for all interactions and decisions in the appropriate systems.

* Follow all applicable pharmacy regulations, internal policies, and procedures related to prior authorizations and prescription benefits.

* Meet established productivity, quality, and turnaround time metrics while maintaining strong attention to detail.

* Collaborate with pharmacists, pharmacy technicians, and other team members to support seamless prior authorization operations.

* Participate in training, coaching, and ongoing education to stay current with plan criteria, systems, and processes.

Essential Skills

* High school diploma or GED.

* Current registration as a pharmacy technician in the state of residence.

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

* Active pharmacy technician license and registration as required by the state of operation.

* Pharmacy technician certification (e.g., Certified Pharmacy Technician, Registered Pharmacy Technician).

* Experience as a pharmacy technician in environments such as retail pharmacy, hospital pharmacy, PBM, call center, or specialty pharmacy.

* Familiarity with prior authorization processes and coverage determination for prescription benefits.

* Basic to strong computer skills, including proficiency with Microsoft Office, Outlook, and data entry.

* Ability to work efficiently within multiple computer systems and on multiple screens.

* Strong attention to detail and accuracy in data entry and documentation.

* Ability to interpret and apply coverage criteria and clinical information to prior authorization requests.

* Customer service skills for interacting with providers, members, and internal stakeholders.

* Ability to work scheduled shifts Monday through Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, including rotating weekends and some holidays.

* Reliable high-speed internet (Wi-Fi) and the ability to maintain a dedicated workspace with a closing door for privacy and focus.

Additional

Skills & Qualifications

* Experience working with prescription benefit management (PBM) systems and prescription benefit coverage.

* Experience in Medicare and Medicaid prescription benefits.

* Experience in call center environments handling healthcare or pharmacy-related inquiries.

* Prior work in specialty pharmacy or handling specialty medications.

* Strong typing and data entry skills with the ability to manage high volumes of electronic requests.

* Ability to manage minimal phone work, primarily outbound calls to providers and prescribers when needed.

* Comfort working in a structured, metric-driven environment with performance expectations.

* Interest in long-term career growth within a large, nationwide healthcare organization.

* Desire to transition from contract to permanent employment, with access to benefits and paid time off upon conversion.

Work Environment

This role operates in a fully remote, professional environment…