Job Description
We are seeking a dedicated Pharmacy Technician to review Prior Authorizations for determination in a large healthcare insurance environment. The role involves approving or denying requests and forwarding them to a pharmacist for final review. You will handle various health plans and medication types, with minimal phone work required.
ResponsibilitiesTrack coverage determination requests submitted from providers and determine if a pharmacist review is required.Obtain verbal authorizations and request detailed clinical information from prescribers.Approve coverage determination requests based on defined criteria.Enter and document coverage determination request decisions into the PBM system and notify providers and/or members.Respond to client inquiries regarding authorization approvals and PBM online applications.Refer coverage determination requests for specialty drugs to delegated vendors or clients for processing.Contact providers for additional information to facilitate coverage determination reviews.Notify physicians, providers, and members of coverage determination request decisions.Essential SkillsRegistered Pharmacy Technician in the state of residence.Nationally Certified Technician.High School Diploma or GED.Strong computer skills.Experience with prior authorization processes.Proficiency in Microsoft Office, including Outlook.Customer service skills.Additional Skills & QualificationsExperience in a call center, PBM, hospital, or specialty pharmacy setting.Certified Pharmacy Technician (CPhT) or National Healthcareer Association (NHA) certification.Work Environment
This is a professional remote environment requiring strong wifi and a dedicated office space with a closed door. The shift is Monday-Friday from 7am-8pm in the local time zone, with rotating weekends every 4-6 weeks and occasional holiday work. Training will be conducted from 10am-6:30pm EST. After training, the schedule will be determined based on the local time zone. Overtime is not required but may be offered periodically. Equipment including a computer, monitor, and headset will be provided. Candidates must have a smart phone.
Pay and Benefits
The pay range for this position is $18.00 - $20.00
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & InclusionAt Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our peopleThe company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.