Our client is seeking experienced REMOTE Prior Authorization Pharmacy Technicians to join a growing Pharmacy Benefit Management (PBM) organization. This is an exciting opportunity to become part of a rapidly expanding team focused on improving patient access to medications through accurate, timely, and clinically appropriate prior authorization review.
The ideal candidate will have prior authorization experience in a PBM, health plan, specialty pharmacy, or other non-retail pharmacy setting and be comfortable working in a fast-paced, production-driven environment. This role requires strong attention to detail, excellent communication skills, and the ability to manage a high volume of cases while maintaining quality and compliance standards.
Shift
- Monday–Friday
- 8:00 AM – 5:00 PM PST or CST
- Flexibility to work occasional overtime or weekends based on business needs.
Requirements:
- Active Pharmacy Technician license in good standing.
- Prior authorization experience in a PBM, health plan, specialty pharmacy, or other pharmacy setting OUTSIDE of traditional retail.
- Experience reviewing pharmacy benefit information, insurance requirements, or medication authorization requests.
- Strong understanding of pharmacy claims, insurance benefits, and prior authorization workflows.
Preferred:
- Certified Pharmacy Technician (CPhT).
- Experience with specialty medications.
- Experience working with PA platforms such as CoverMyMeds
- Knowledge of formulary management, step therapy, quantity limits, and utilization management.
- Experience using prior authorization platforms and pharmacy management systems.
- Proficiency with Microsoft Excel.
Responsibilities
- Review and process prior authorization requests in accordance with plan guidelines and established workflows.
- Evaluate requests for completeness and obtain additional clinical or insurance documentation from providers and pharmacies as needed.
- Initiate and track prior authorization renewals and follow up on outstanding requests.
- Communicate authorization determinations and status updates to providers, pharmacies, and internal stakeholders.
- Document all case activity accurately and thoroughly within internal systems.
- Maintain productivity and quality metrics while managing a high-volume workload (30+ cases per day).
- Collaborate with pharmacists and cross-functional teams to support efficient medication access.
- Assist with appeals, reconsiderations, and additional review processes when appropriate.
- Ensure compliance with regulatory requirements, company policies, and utilization management guidelines.
- Identify opportunities to improve workflow efficiency and overall service quality.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
*As a job position within our Allied division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: providing direct patient care, accessing medical and confidential records, accessing and administering prescription medication or other drugs, working within a clinical setting, handling sharp instruments, conducting medical procedures, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
