Clinical Pharmacy Tech – Formulary & Prior Auth Expert

Centene Corporation; United States; Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health insurance

401K

Stock options

Tuition reimbursement

Paid time off

Flexible work schedules

Job summary

Centene Corporation is seeking a Pharmacy Technician to support formulary management, claims processing, and clinical audit tasks. You will review formulary changes, assist with prior authorizations, and handle member benefit questions while maintaining regulatory compliance.

You will contribute to Medicare Part D operations and SHP processes, ensuring accurate documentation and efficient service delivery across multiple health programs.

Qualifications

• High School diploma or GED required.
• 1 year Pharmacy Technician experience required.
• Customer Service/retail experience preferred.

Responsibilities

• Reviews and processes formulary change requests from Health Net plans.
• Submits and maintains formulary change requests to Health Net’s pharmacy claims processor.
• Generates, maintains and reviews Formulary Status Grids.
• Uses reports to perform audits and quality checks on formulary status for accuracy and contract compliance.
• Assists Clinical Pharmacist with formulary database maintenance and website updates.
• Performs pharmacy audit and recovery tasks including reviewing paid claims for discrepancies.
• Handles member inquiries including benefit questions and prior authorizations.
• Reviews requests for non-formulary drugs and documents authorizations accordingly.
• Assigns and documents prior authorizations in claims systems.
• Tracks PDE files and participates in prescription coverage determinations.

Skills

Customer service

Pharmacy terminology

Education

High School diploma or GED

1 year Pharmacy Technician experience

Customer Service/retail experience preferred

Job description

Centene Corporation is seeking a Pharmacy Technician to support formulary management, claims processing, and clinical audit tasks. You will review formulary changes, assist with prior authorizations, and handle member benefit questions while maintaining regulatory compliance.

You will contribute to Medicare Part D operations and SHP processes, ensuring accurate documentation and efficient service delivery across multiple health programs.