Job Description

OVERVIEW :

Our client, a major PBM (Pharmacy Benefit Services) entity owned by 20 non-profit health plans serving >33 million members and benefits manager of government programs including Medicare and Medicaid, seeks an accomplished Certified Pharmacy Technician .

IMPORTANT NOTES:

• OCT 2025, Class
• CLIENT IS HIRING CALIFORNIA RESIDENTS ONLY.
• Target Start Date: 11/03/2025.
• LOCATION: 100% REMOTE/ WORK FROM HOME
• DURATION: 6 months possible temp to hire
• WORK SHIFTS: Client Ops are 24/7. Hires would be spread across shifts, so candidates must be flexible to any of below shifts / schedules [Client will be flexible with shift hours/ can approve preferred shift hours].
• SHIFT / WORKING HOURS: 8 hours per day || Start time varies between 8am to 12:30pm || No Graveyard Shift || 5 days of the week (Monday-Sunday)
• Training: 4 Weeks Total || 08:30am - 05:00pm (Pacific Time)
• TIME-OFF POLICY: No time-off during Training || No absences in first 90 days preferred

IMPORTANT Remote / Work-From-Home related:

• Equipment will be provided.
• Candidate MUST have high-speed wired Internet connection. Wi-Fi / Wireless connections not allowed.
• Reliable Internet connection- (No WI-FI) ethernet connection At least 150MBPS(Uninterrupted).
• Candidate MUST have a reliable home-office environment.

RESPONSIBILITIES:

• The Pharmacy Technician is responsible for evaluating & authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or fax using client criteria. Primary duties may include, but not limited to:
• Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Researches, resolves and documents prior authorization outcomes in pharmacy system.
• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.
• Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• Verifies member information and inputs data for the pharmacists.
• Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs.
• Processes prior authorization requests from physicians’ offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations.
• Provides resolution to grievances and appeals issues.
• Maintains record keeping of prior authorizations, rebates, and monthly reports.

QUALIFICATIONS / REQUIREMENTS:

• Requires High School diploma or GED.
• 2-4 years of Pharmacy Technician experience.
• California State Pharmacy Tech Certification based on applicable state(s) (preferred).
• Should have in-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in Pharmacy computerized systems and software applications, as well as Windows-based applications and MS Office Product Suite.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• Ability to respond to escalated concerns in a calm and professional manner in attempts to prevent further escalations.

I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you are looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

Recruiter Name: Jatin Rattan

Title: Senior Recruiter

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