Pharmacy Utilization Review Technician

Prime Therapeutics; Austin (TX); On-site; USD 32,000 - 51,000; Full time

Job summary

Prime Therapeutics is seeking an Initial Review Pharmacy Technician in Austin, TX to support utilization management and reimbursement determinations. The role involves reviewing requests, communicating with physicians and patients, and ensuring quality and regulatory compliance.

Responsibilities include documenting outcomes, performing program integrity audits, and collaborating with clinical teams to resolve issues.

Qualifications

• Associate's degree or equivalent required.
• Pharmacy technician licensure per state requirements.
• 2+ years of Pharmacy Experience.
• CPT/ExCPT/LPT/PTCB/RPT certification required or eligible.
• Experience in Utilization Management or claim adjudication is preferred.

Responsibilities

• Reviews patient information and checks appropriateness using clinical criteria.
• Makes approval recommendations for services meeting criteria.
• Audits program integrity and reviews medical records for Prior Authorization.
• Documents communications with physicians and patients.
• Determines eligibility for reimbursement based on criteria and enters approvals/denials.

Skills

Pharmacy experience

Utilization management

Excellent communication

Team oriented

Customer service

Education

Associate's degree or equivalent

Pharmacy technician licensure

Tools

MS Office

Proprietary systems

Job description

Prime Therapeutics is seeking an Initial Review Pharmacy Technician in Austin, TX to support utilization management and reimbursement determinations. The role involves reviewing requests, communicating with physicians and patients, and ensuring quality and regulatory compliance.

Responsibilities include documenting outcomes, performing program integrity audits, and collaborating with clinical teams to resolve issues.