Remote Pharmacy Technician

Remote Pharmacy Technician

This remote Pharmacy Technician role focuses on reviewing prior authorization requests and supporting coverage determinations for a pharmacy services department within a large healthcare insurance organization. You will evaluate requests for a wide range of medications across multiple health plans, enter decisions into pharmacy benefit systems, and collaborate closely with pharmacists for final review. The position offers minimal phone work, a structured schedule, and the opportunity to transition to a permanent role with long-term career growth.

Responsibilities

• Review prior authorization requests for prescription medications to support coverage determinations in accordance with established criteria and guidelines.
• Approve or deny coverage requests based on documented criteria and route all decisions to a pharmacist for final review and sign-off.
• Track and manage coverage determination requests from receipt through completion, ensuring timely and accurate processing.
• Enter decisions and related documentation into the pharmacy benefit management (PBM) system and other internal platforms with a high level of accuracy.
• Obtain verbal authorizations from prescribers or their offices and request detailed clinical information as needed to support coverage decisions.
• Notify providers, members, and other stakeholders of coverage decisions and outcomes in a clear and professional manner.
• Handle prior authorization requests for all health plans and all types of medications, including specialty and high-cost therapies.
• Respond to client inquiries related to prescription benefit coverage, prior authorization status, and related issues.
• Refer requests involving specialty medications or complex therapies to the appropriate specialty drug teams or clinical resources.
• Contact providers, prescribers, or their staff to clarify prescriptions, gather missing information, or resolve discrepancies in prior authorization requests.
• Assist with inbound and outbound patient or physician calls as needed, while maintaining a primarily non-phone-based workflow.
• Use multiple computer screens and systems simultaneously to review clinical information, update records, and document all activities.
• Maintain high standards of data entry accuracy, ensuring that all information entered into systems is complete, correct, and compliant with internal procedures.
• Demonstrate strong customer service skills when interacting with providers, members, and internal partners, ensuring a professional and courteous experience.
• Adhere to all regulatory, compliance, and company policies related to pharmacy practice, privacy, and prescription benefits.
• Meet or exceed performance metrics, quality standards, and productivity expectations as defined by the department.
• Participate in training sessions and ongoing education to stay current with policies, systems, and prior authorization criteria.
• Collaborate with pharmacists, pharmacy technicians, and other team members to ensure efficient workflow and consistent application of coverage criteria.

Essential Skills

• High school diploma or GED.
• Current registration as a pharmacy technician in the state of residence.
• National certification as a Pharmacy Technician (e.g., PTCB or NHA).
• Active Pharmacy Technician license and registration as required by the state of operation.
• Certified Pharmacy Technician (CPhT) or equivalent national certification.
• Registered Pharmacy Technician status in applicable state.
• Strong computer skills, including the ability to work efficiently in multiple systems and on multiple screens.
• Basic to strong proficiency with Microsoft Office, including Outlook.
• Proficiency in data entry with high accuracy and attention to detail.
• Experience or familiarity with prior authorization processes for prescription benefits.
• Ability to navigate PBM (Pharmacy Benefit Management) systems and prescription benefit platforms.
• Strong customer service skills, including clear communication and professional interaction with providers and members.
• Ability to work in a call centerstyle environment if needed for inbound or outbound calls.
• Reliable high-speed Wi-Fi and the ability to maintain a dedicated, private workspace with a closing door for remote work.
• Ability to work Monday through Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, with rotating weekend and some holiday coverage.