Prior Authorization Technician
$29.08 per hourElevait Solutions
Job Summary: Prior Authorization Technician (Remote, US) This is a contract role supporting a leading pharmacy benefit management (PBM) team in processing prior authorization (PA) requests for medications, including high-cost specialty drugs. As a Prior Authorization Technician, you will play a key role in ensuring patients receive timely access to necessary medications by reviewing clinical criteria, interpreting claims, and facilitating communication between providers, pharmacies, and patients. The position is fully remote, with shift hours set in EST, and requires flexibility to work weekends and holidays. Key Skills Required
- Prior authorization processing
- Clinical criteria interpretation
- Pharmacy claims systems
- Call handling (inbound/outbound) Key Responsibilities
- Interpret and apply clinical criteria during prior authorization reviews
- Utilize member claims history to inform decisions
- Make outbound calls to collect additional information for requests
- Submit authorizations to pharmacy and medical claims processors
- Forward requests to pharmacists as needed
- Refer cases to clinical programs or in-network providers when appropriate
- Receive inbound calls regarding prior authorization inquiries
- Assist with appeals processing as assigned
- Complete required annual training What Makes This Role Attractive?
- Fully Remote: No commute; work from anywhere in the US
- Competitive Pay: Up to $29.08/hr, above most comparable remote PBM technician roles
- Reputable Employer: Work with Elevait Solutions, a certified Service Disabled Veteran Owned Small Business recognized for its candidate care and transparency
- Specialized Experience: Opportunity to build expertise in specialty medication authorizations and PBM systems Preferred/Bonus Skills
- Experience in PBM, managed care, hospital, LTC, home infusion, or retail pharmacy settings Candidate Profile
- Certified Pharmacy Technician (PTCB or NHA)
- 1 3 years of relevant pharmacy or prior authorization experience
- Strong communication and clinical review skills
- Comfortable with high-volume call environments
- Able to work non-standard hours, including weekends and holidays Recruiter Insights
- Remote flexibility and industry-leading pay make this role highly competitive
- Target candidates with prior PBM or pharmacy authorization experience for best fit
- Shift flexibility and EST schedule adherence are essential screen for candidate adaptability
- No conversion to FTE; set clear expectations regarding the contract term Candidate Insights
- Work from home with no commute and set schedules
- Above-market compensation in a short-term, high-impact role
- Gain valuable experience with a top PBM and exposure to specialty medication authorizations
- Join a team that values open communication, support, and transparent placement processes
- Prior authorization processing
- Clinical criteria interpretation
- Pharmacy claims systems
- Call handling (inbound/outbound) Key Responsibilities
- Interpret and apply clinical criteria during prior authorization reviews
- Utilize member claims history to inform decisions
- Make outbound calls to collect additional information for requests
- Submit authorizations to pharmacy and medical claims processors
- Forward requests to pharmacists as needed
- Refer cases to clinical programs or in-network providers when appropriate
- Receive inbound calls regarding prior authorization inquiries
- Assist with appeals processing as assigned
- Complete required annual training What Makes This Role Attractive?
- Fully Remote: No commute; work from anywhere in the US
- Competitive Pay: Up to $29.08/hr, above most comparable remote PBM technician roles
- Reputable Employer: Work with Elevait Solutions, a certified Service Disabled Veteran Owned Small Business recognized for its candidate care and transparency
- Specialized Experience: Opportunity to build expertise in specialty medication authorizations and PBM systems Preferred/Bonus Skills
- Experience in PBM, managed care, hospital, LTC, home infusion, or retail pharmacy settings Candidate Profile
- Certified Pharmacy Technician (PTCB or NHA)
- 1 3 years of relevant pharmacy or prior authorization experience
- Strong communication and clinical review skills
- Comfortable with high-volume call environments
- Able to work non-standard hours, including weekends and holidays Recruiter Insights
- Remote flexibility and industry-leading pay make this role highly competitive
- Target candidates with prior PBM or pharmacy authorization experience for best fit
- Shift flexibility and EST schedule adherence are essential screen for candidate adaptability
- No conversion to FTE; set clear expectations regarding the contract term Candidate Insights
- Work from home with no commute and set schedules
- Above-market compensation in a short-term, high-impact role
- Gain valuable experience with a top PBM and exposure to specialty medication authorizations
- Join a team that values open communication, support, and transparent placement processes
Vacancy posted 2 days ago
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