Clinical Utilization Review Pharmacy Technician

Prime Therapeutics; United States; Remote; USD 32,000 - 51,000; Full time

Job summary

Prime Therapeutics is seeking a Pharmacy Technician to support utilization management programs across health plans. The role involves reviewing prospective and retrospective requests for therapeutic appropriateness, communicating with physicians, patients, and pharmacies, and ensuring timely documentation and adherence to NCQA standards.

Ideal candidates will have an Associate degree or equivalent, 2+ years of pharmacy experience, and active licensure/registration as required by state law.

Qualifications

• Associate degree or equivalent combination of education and experience.
• 2+ years of Pharmacy Experience.
• Active pharmacy technician licensure/registration as required by state.

Responsibilities

• Review patient information and determine appropriateness based on clinical criteria.
• Make approval recommendations or refer cases for pharmacist review.
• Document communications with physicians, prescribers, and pharmacies.
• Assist with program integrity audits and claims-related inquiries.
• Support intake calls and order entry when needed.

Skills

Verbal communication

Written communication

Customer service

Analytical reasoning

Education

Associate's degree or equivalent

Bachelor's degree in Science/Health/Related

Tools

Microsoft Office

Proprietary systems

Job description

Prime Therapeutics is seeking a Pharmacy Technician to support utilization management programs across health plans. The role involves reviewing prospective and retrospective requests for therapeutic appropriateness, communicating with physicians, patients, and pharmacies, and ensuring timely documentation and adherence to NCQA standards.

Ideal candidates will have an Associate degree or equivalent, 2+ years of pharmacy experience, and active licensure/registration as required by state law.