About this role
Accountabilities:
- Review, research, and process pharmacy prior authorization requests in accordance with established criteria, policies, regulatory requirements, and applicable service-level agreements.
- Research and resolve member, provider, and pharmacy inquiries and escalations, providing accurate information and appropriate follow-up.
- Accurately document calls, authorization activities, inquiries, and resolutions while maintaining compliance with HIPAA, PHI, and applicable program requirements.
- Serve as a pharmacy subject matter resource and support new-hire training, continuing education, coaching, and development for pharmacy technician team members.
- Monitor quality and operational trends, identify opportunities for improvement, and collaborate with supervisors and leadership to support service, productivity, and quality objectives.
- Independently manage assigned responsibilities while maintaining effective communication with members, providers, pharmacies, pharmacy technicians, leadership, and other internal stakeholders.
Requirements:
- Active Certified Pharmacy Technician credential, such as PTCB/CPhT, ExCPT, or an equivalent certification, is required.
- At least 2 years of relevant pharmacy technician experience, preferably within managed care, health insurance, pharmacy benefit management, pharmacy benefits, or a related healthcare environment.
- Experience with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider, or pharmacy support.
- Previous experience training, coaching, mentoring, or serving as a subject matter resource for pharmacy technicians or healthcare operations staff is preferred.
- Strong communication, research, problem-solving, computer, and organizational skills, with the ability to navigate multiple systems effectively.
- Ability to work independently and maintain accuracy and productivity in a fast-paced remote environment.
- Reliable high-speed internet and a professional, distraction-free home workspace are required.
Benefits:
- Annual salary range of $44,900–$64,100 USD, with actual compensation varying based on factors including geographic region, internal equity, job-related knowledge, skills, and experience.
- 100% remote/work-from-home position for candidates residing within the United States.
- Full-time, non-exempt employment with a Monday–Friday schedule of either 8:00 AM–4:30 PM EST or 9:00 AM–5:30 PM EST.
- Medical, dental, and vision coverage, subject to applicable eligibility requirements.
- 401(k) retirement savings plan with employer match.
- Paid time off and flexible vacation benefits for eligible full-time employees.
- Additional wellness and financial programs designed to support employee well-being.
- Educational assistance and access to leadership and technical development academies.
- Opportunities for continuous learning, career development, and professional growth.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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