Remote Certified Pharmacy Technician

Remote Pharmacy Technician – Prior Authorization Review

This remote Pharmacy Technician role focuses on reviewing pharmacy prior authorization requests for a large health insurance pharmacy services department. You evaluate coverage determinations for a wide range of health plans and medications, approve or deny requests based on established criteria, and route them to pharmacists for final review. The position involves detailed computer-based work in a professional virtual environment, with minimal phone interaction and the opportunity to grow into a long-term, permanent role with benefits.

• Review pharmacy prior authorization requests for coverage determination across multiple health plans and medication types.
• Evaluate requests against established criteria and either approve or deny them prior to pharmacist review.
• Enter coverage decisions accurately into the Pharmacy Benefit Management (PBM) system and other internal platforms.
• Track coverage determination requests from receipt through final decision and documentation.
• Obtain verbal authorizations from prescribers and request detailed clinical information when needed to support decision-making.
• Notify providers, members, and other stakeholders of coverage decisions in a clear and timely manner.
• Respond to client and provider inquiries related to prescription benefits, prior authorizations, and coverage determinations.
• Refer requests for specialty medications or complex cases to appropriate internal teams or pharmacists.
• Contact providers for additional clinical or administrative information required to complete prior authorization reviews.
• Assist with inbound and outbound patient or physician calls as needed, with a focus on outbound communication.
• Handle Medicare and Medicaid prescription benefit inquiries in accordance with applicable guidelines and policies.
• Use multiple computer systems and screens simultaneously to review requests, document decisions, and update records.
• Maintain high standards of accuracy, data entry quality, and confidentiality in all documentation and communications.
• Meet performance metrics related to productivity, quality, and turnaround time for prior authorization reviews.
• Collaborate with pharmacists and other team members to ensure consistent application of coverage criteria and processes.
• Provide professional customer service to members, prescribers, and internal stakeholders in a call center–style environment when required.

• High school diploma or GED.
• Current registration as a pharmacy technician in the state of residence, in good standing.
• National pharmacy technician certification (such as PTCB or NHA).
• Active Pharmacy Technician Certification (e.g., Certified Pharmacy Technician, CPhT).
• Pharmacy technician license and registration as required by the state of operation.
• Experience as a pharmacy technician in retail, hospital, PBM, call center, or specialty pharmacy settings.
• Proficiency in prior authorization processes and prescription benefits review.
• Strong computer skills, including working with multiple screens and systems simultaneously.
• Basic to advanced skills in Microsoft Office applications, including Outlook.
• Accurate and efficient data entry skills with attention to detail.
• Customer service experience in a healthcare, pharmacy, or call center environment.
• Ability to work remotely with reliable high-speed Wi-Fi and a dedicated workspace.
• Ability to work Monday–Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, with rotating weekend and some holiday coverage.

• Experience working with Pharmacy Benefit Management (PBM) systems.
• Background in Medicare and Medicaid prescription benefits.
• Prior experience in retail pharmacy, hospital pharmacy, or specialty pharmacy.
• Familiarity with call center operations and workflows in a healthcare or insurance setting.
• Strong written and verbal communication skills for interacting with prescribers, members, and internal teams.
• Ability to interpret and apply coverage criteria and clinical information to authorization decisions.
• Comfort working with multiple technology platforms and electronic documentation tools.
• Ability…