Prior Authorization Pharmacy Technician

Prior Authorization Pharmacy Technician

Location: Charleston, WV (On-site)

We are seeking a Prior Authorization Pharmacy Technician to review and process prior authorization requests against plan clinical criteria for our client. This position is a full-time, direct hire opportunity based onsite in Charleston, WV. The role triages incoming requests, applies formulary rules, step therapy requirements, and quantity limits, renders determinations within published criteria, and documents each case in the PBM platform.

This role is well aligned for a pharmacy technician ready to move from retail, hospital, or mail order settings into a structured, queue based role with a clear performance framework. The ideal candidate brings a detail driven approach, comfort on the phone with prescriber offices, and motivation for accurate, compliant work at volume.

Responsibilities:

• Triage incoming PA requests via fax, electronic platforms, and phone, and verify required fields and documentation completeness
• Apply plan-specific clinical criteria, formulary rules, step therapy requirements, and quantity limits to each PA request
• Render approval determinations independently within published criteria, and escalate cases requiring clinical pharmacist judgment
• Contact prescriber offices by phone or fax to request missing clinical documentation and medical necessity letters
• Document PA cases thoroughly in the PBM platform, including clinical rationale, communications, and determination outcomes
• Navigate CoverMyMeds, Surescripts, and proprietary PA platforms while maintaining accuracy under volume pressure
• Meet federally mandated turnaround times for urgent, standard, and retrospective PAs across all lines of business
• Route complex cases to pharmacist reviewers with a complete handoff summary, including request details, documentation, criteria, and recommendations
• Communicate PA determinations (approved, denied, pended) to prescribers and internal teams with clear reasoning language

Qualifications:

• Active PTCB certification or current state pharmacy technician license in good standing required
• Minimum of 2 years of pharmacy technician experience, with prior authorization or PBM experience strongly preferred
• Working knowledge of commercial insurance, Medicare Part D, and Medicaid PA workflows, step therapy, and quantity limits
• Experience with CoverMyMeds, Surescripts, or similar PA platforms, with the ability to learn new systems quickly with minimal training
• Strong phone presence and confident communication when contacting prescriber offices under volume pressure
• Ability to document clinical details, determination rationale, and communication logs clearly in regulated, auditable environments

Schedule: Full-time position

Onsite in Charleston, WV

Monday through Friday, standard business hours (Eastern Time)

40 hours per week

Salary Range: The salary range for this position is approximately $37,000 – $48,000 annually ($17.79 – $23.08 per hour), based on experience and qualifications.

Interview Process: Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.