Senior Clinical Pharmacy Technician - Remote Prior Authorization Specialist - Pharmacy Benefits Management

Join Our Team: Making a Difference in Healthcare

At Prime Therapeutics LLC, we're passionate about helping people access the medications they need to live healthy, fulfilling lives. Our work matters, and it fuels our passion and drives every decision we make. As a Senior Clinical Pharmacy Technician - Remote Prior Authorization Specialist, you'll play a critical role in our pharmacy benefits management team, working closely with prescribers, pharmacists, and other healthcare professionals to ensure that our members receive the medications they need.

Job Summary

We're seeking a highly skilled and experienced Senior Clinical Pharmacy Technician to join our remote team. As a Senior Clinical Pharmacy Technician - Remote Prior Authorization Specialist, you'll be responsible for evaluating and authorizing prior authorization pharmacy requests from prescribers, communicating with healthcare professionals, and resolving prior authorization outcomes. If you're a motivated and detail-oriented pharmacy professional looking for a challenging and rewarding role, we encourage you to apply.

Key Responsibilities

• Prior Authorization Review and Approval: Evaluate and authorize prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
• Communication and Collaboration: Communicate decisions to physicians, physician's office staff, medical management staff, and/or pharmacists, and provide information on selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives.
• Escalation and Clinical Review: Escalate requests to Pharmacists when extensive clinical review or denial is required.
• Telephone System Monitoring: Monitor the telephone system to ensure adequate staffing to maintain client service levels.
• Training and Mentorship: Assess training needs within the team, serve as a training resource, mentor, and coach to others, and identify and share best practices.
• Team Environment: Demonstrate, advocate, and reinforce a positive team environment.
• Other Duties: Perform other duties as assigned.

Essential Qualifications

Education and Experience

• Education Level: GED or High School diploma required.
• Certifications and Licensure: Active pharmacy technician licensure or registration in accordance with state requirements, and/or national certification (e.g., PTCB or ExCPT).
• Experience: 2+ years of pharmacy experience, with a focus on prior authorization, reimbursement, or health plan/healthcare setting.

Skills and Competencies

• Pharmacy Knowledge: In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology, and current diagnostic and reimbursement coding.
• Computer Systems and Software: Proficiency in pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• Communication and Interpersonal Skills: Excellent written and verbal communication skills, with the ability to communicate effectively with healthcare professionals.
• Analytical and Problem-Solving Skills: Ability to analyze complex information, identify and troubleshoot problematic issues, and make sound judgments.

Preferred Qualifications

• Specialty or Retail Pharmacy Experience: Experience working in specialty or retail pharmacy, prior authorization, or health plan/healthcare setting.
• National Certification: Active national certification (e.g., PTCB or ExCPT).
• Dispensing or Retail Experience: Minimum of 2 years of dispensing or retail experience required, or equivalent internal training.

Physical Demands

• Stationary Position: Must be able to remain in a stationary position 50% of the time.
• Computer and Office Equipment: Must be able to constantly operate a computer and/or other office productivity equipment.
• Communication and Hearing: Must be able to hear and constantly communicate information and ideas.
• Lifting and Moving: Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.

What We Offer

Compensation and Benefits

We offer a competitive salary range of $19.23 - $28.85 per hour, based on experience and skills. Our comprehensive benefits package includes:

• Medical, Dental, and Vision Coverage
• Retirement Savings Plan
• Paid Time Off
• Flexible Work Arrangements

For more information on our benefits, incentives, and additional compensation, please visit our Benefits Page.

Career Growth and Learning Opportunities

At Prime Therapeutics LLC, we're committed to the growth and development of our employees. We offer:

• Training and Mentorship Programs
• Career Advancement Opportunities
• Professional Development Resources

Our Culture and Values

We're proud to be an equal opportunity and affirmative action employer. We welcome people of different backgrounds, experiences, abilities, and perspectives, including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

As a Tobacco-Free Workplace employer, we're committed to creating a healthy and safe work environment for all employees.

How to Apply

If you're a motivated and detail-oriented pharmacy professional looking for a challenging and rewarding role, we encourage you to apply. Please submit your application through our website: Apply Job! or Apply to this Job.

Don't miss this opportunity to join our team and make a difference in healthcare. Apply today!