Clinical Pharmacy Technician

Clinical Pharmacy Technician Sr - Medi-Cal Rx (Remote California)The Senior Clinical Pharmacy Technician – Medi-Cal independently manages prior authorization requests, eligibility, pharmacy benefits, and claims using established clinical criteria. This role serves as a technical resource to team members, supports resolution of non-routine cases, and identifies opportunities to improve workflow efficiency.ResponsibilitiesIndependently review, research, and resolve prior authorization requests by applying clinical criteria, established guidelines, and professional judgment within defined protocolsCommunicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring clarity and accuracy in non-routine scenariosManage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations, resolving moderately complex issues and determining appropriate next stepsEscalate clinically complex or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support timely resolutionEducate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networksInitiates, prioritize, and manage cases by accurately gathering and entering member and provider informationIdentify trends, root causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, quality, and consistencyServe as a resource to team members by providing guidance, answering process questions, and supporting onboarding activitiesOther duties as assignedMinimum QualificationsHigh school diploma from an accredited school or equivalent GED2 years of work experience as a pharmacy technicianLicensed Pharmacy Technician in accordance with California state requirementsMust be eligible to work in the United States without the need for work visa or residency sponsorshipAdditional QualificationsStrong knowledge of pharmacy workflows, terminology, and reimbursement processesAbility to prioritize work and manage multiple assignments in a dynamic environmentEffective communication skills with the ability to guide and support team membersProficiency in pharmacy systems and Microsoft Office applicationsPreferred Qualifications1 year reimbursement experiencePBM or health care experienceEvery employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and proceduresEvery employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this jobPotential pay for this position ranges from $19.23 - $28.85 based on experience and skills.Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.Prime Therapeutics LLC is a Tobacco-Free Workplace employer.