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.

• 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.

• 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.

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

• Experience in Medicare and Medicaid…