Certified Pharmacy Technician - 259805

Medix™; United States; Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Remote work

Equipment provided

Job summary

Medix™ is seeking a remote Prior Authorization Specialist with experience in PBM, health plan operations, and PA workflows. This role focuses on reviewing PA requests, coordinating with providers and pharmacies, and documenting decisions to support medication access.

Top performers may transition into a permanent role based on performance. The position offers full remote work with standard hours, and a competitive hourly rate of $20–$23.

Qualifications

• Experience in a PBM or health plan setting.
• Knowledge of prior authorization processes and insurance guidelines.
• Strong attention to detail and organizational skills.

Responsibilities

• Review PA requests and determine coverage eligibility based on clinical criteria and health plan guidelines.
• Coordinate with providers, pharmacies, and members to obtain documentation and communicate determinations.
• Maintain accurate PA documentation in internal systems.

Skills

PBM experience

PA workflows

Attention to detail

Communication skills

Case management

Job description

Contract Opportunity with Potential for Permanent Hire

Are you an experienced Pharmacy Technician with a background in prior authorizations, pharmacy benefits, or health plan operations? We’re looking for a detail-oriented Prior Authorization Specialist to join our team!

This is an excellent opportunity for someone who understands pharmacy benefits and prior authorization workflows and enjoys helping providers, pharmacies, and members navigate medication coverage decisions. Top performers may have the opportunity to transition into a permanent position!

What You’ll Do

• Review prior authorization (PA) requests and determine coverage eligibility based on clinical criteria and health plan guidelines.
• Coordinate with providers, pharmacies, and members to obtain clinical documentation, communicate determinations, and complete follow-up outreach.
• Maintain accurate documentation of PA requests, renewals, coverage decisions, and case updates in internal systems.
• Assist with reconsiderations, appeals, and administrative tasks supporting clinical operations.
• Ensure compliance with regulatory requirements, health plan policies, and established procedures.
• Identify opportunities to improve workflow efficiency, accuracy, and service quality.

What We’re Looking For

• Experience in a Pharmacy Benefit Manager (PBM), PBM-adjacent organization, health plan, or pharmacy-related setting.
• Knowledge of prior authorization processes and insurance benefit guidelines.
• Strong attention to detail, documentation accuracy, and organizational skills.
• Excellent written and verbal communication and problem-solving abilities.
• Ability to manage multiple cases, priorities, and deadlines in a fast-paced environment.

Preferred Qualifications:

• Familiarity with pharmacy claims processing, prior authorization platforms, and formulary structures.

Why Consider This Opportunity?

• 100% remote work with equipment provided.
• Competitive pay of $20-$23 per hour.
• Monday-Friday schedule with consistent hours.
• Contract opportunity with potential for permanent employment based on performance.
• Opportunity to build experience in pharmacy benefits, medication access, and healthcare operations.