Senior Pharmacy Technician, Utilization Management

The role

The Senior Pharmacy Technician leads non-clinical administration of pharmacy utilization management programs. This person processes prior authorization requests, manages technician workflows, and serves as a subject matter expert for UM technology and operations.

What you will do

• Receive, process, and conduct non-clinical review of pharmacy prior authorization requests
• Verify member eligibility, benefit coverage, and authorization requirements
• Enter, update, and maintain authorization records within UM and pharmacy claims systems
• Obtain and document information from providers, pharmacies, and members
• Route requests to pharmacists when clinical judgment is required
• Communicate authorization status to providers, pharmacies, and members
• Manage workload distribution and queue prioritization for the UM technician team
• Conduct quality reviews and provide coaching, feedback, and training to technicians
• Serve as a super-user for prior authorization technology platforms
• Lead implementation of formulary updates and system enhancements

Required qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Pharmacy, Health Sciences, or a related field
• 5+ years of pharmacy technician experience
• At least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations
• Active pharmacy technician registration, licensure, or other credential required by the state(s) in which the employee performs services
• Current Certified Pharmacy Technician (CPhT) credential
• Prior experience in a senior technician, trainer, quality reviewer, or workflow coordinator capacity
• Experience supporting operational configuration, user acceptance testing, validation, implementation, or maintenance of prior authorization or UM technology platforms
• Experience supporting pharmacy benefit configuration, formulary changes, clinical program implementation, audits, or process-improvement initiatives
• Familiarity with NCQA, URAC, ERISA, state-specific, or other applicable utilization management and pharmacy benefit requirements
• Demonstrated experience training, mentoring, coaching, or coordinating the work of others
• Working knowledge of pharmacy prior authorization operations, pharmacy benefits, formulary management, exception processing, and appeals support
• Experience using utilization management platforms, pharmacy claims systems, and Microsoft Office applications

Benefits

• Competitive compensation
• health
• dental
• vision
• other benefits

Before you apply

• Dedicated, private, and secure remote work environment that meets organizational requirements

About the company

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. They utilize clinical approaches and state-of-the-art technology to make pharmacy benefits easy to understand and access.