Remote Certified Pharmacy Technician

The Certified Pharmacy Technician evaluates and authorizes Medicaid prior authorization pharmacy requests in a high-volume call center environment, using established clinical criteria and clear step-by-step guidelines. This role focuses on determining medication appropriateness, documenting outcomes in pharmacy systems, and communicating coverage decisions and formulary alternatives to prescribers, providers, and pharmacy professionals. The position is fully remote and offers structured training, modern equipment, and the potential to extend or convert after the initial one-year contract.

• Evaluate and authorize Medicaid prior authorization pharmacy requests from prescribers received by telephone, following defined clinical criteria.

• Determine the appropriateness of prescribed medications based on established guidelines and client criteria.

• Communicate prior authorization decisions to physicians, physician office staff, medical management staff, and pharmacists in a clear and professional manner.

• Document all prior authorization outcomes accurately in the pharmacy system to ensure complete and compliant records.

• Explain applicable prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to prescribers, office staff, medical management staff, and pharmacists.

• Escalate requests to a Pharmacist when cases require extensive clinical review or when a denial is indicated, following step-by-step escalation procedures.

• Record physician and client inquiries, grievances, and outcomes, and provide verbal or written responses to prescribers, providers, clients, and internal management as needed.

• Process and clinically review coverage determinations for medications received via fax, ensuring attention to detail and adherence to criteria.

• Communicate coverage decisions for faxed requests within established service level agreement (SLA) time frames.

• Efficiently multitask and monitor several work queues and assignments, including fax work, pending queues, oral notifications, and failed faxes.

• Adapt to changing team and business requirements, shifting focus among different queue types and workflows as needed.

• Navigate multiple computer systems and applications to research, document, and process prior authorization requests.

• Deliver a high level of customer service to prescribers, office staff, and pharmacy professionals, maintaining professionalism in all interactions.

• Work independently in a fast-paced remote environment while meeting productivity, quality, and SLA expectations.

• Active state pharmacy technician registration or license, verified through the appropriate State Board of Pharmacy.

• National pharmacy technician certification (CPhT) through PTCB or NHA, with verifiable certification status.

• High School Diploma or GED.

• At least 1 year of experience in a retail or call center pharmacy environment (3 or more years preferred).

• Strong medical and health literacy, with the ability to comprehend clinical information and communicate it effectively.

• Strong written and verbal communication skills for interacting with prescribers, office staff, and pharmacy professionals.

• Excellent attention to detail and organizational skills to ensure accurate documentation and compliance.

• Comfort and proficiency in navigating multiple computer systems and applications simultaneously.

• Ability to work independently and reliably in a fast-paced, remote setting.

• Experience with pharmacy data entry and prior authorization processes.

• Previous experience in pharmacy benefit management, prior authorization, healthcare, or commercial insurance environments.

• Customer service or call center experience, particularly within healthcare, pharmacy, or insurance settings.

• Familiarity with Medicaid pharmacy benefits and formulary management.

• Demonstrated ability to efficiently multitask and manage several queues and assignments.

• Strong problem-solving skills and the ability to follow structured clinical and operational workflows.

• Interest in long-term engagement, with the potential to extend or convert after the initial one-year contract.

This is a 100% remote position, open to candidates located in the United States except in California, Hawaii, and Puerto Rico. The role is based in a call center-style environment, conducted entirely from home using company-provided equipment, including a laptop, mouse and keyboard,…