Remote Certified Pharmacy Technician - Medicaid PA Expert

Actalent; Tucson (AZ); À distance; USD 26 000 - 34 000; Plein temps

Résumé du poste

Actalent is seeking a Fully Remote Certified Pharmacy Technician to evaluate and authorize Medicaid prior authorization requests in a high-volume call center. The role focuses on clinical appropriateness using established criteria, documenting outcomes, and communicating decisions to healthcare professionals.

Candidates must have a high school diploma or GED, active state registration, PTCB/NHA certification, and 1+ year experience in a retail or call center pharmacy environment.

Qualifications

• High school diploma or GED.
• Active state pharmacy technician registration or license.
• National pharmacy technician certification (PTCB or NHA).
• At least 1 year of experience in a retail or call center pharmacy environment (3+ years preferred).
• Experience with prior authorization processes in a pharmacy or related setting.
• Proficient data entry skills with a high level of accuracy.
• Strong written and verbal communication skills for interacting with healthcare professionals and internal teams.
• Excellent attention to detail and organizational skills.
• Ability to navigate multiple computer systems and applications simultaneously.
• Ability to work independently and maintain productivity in a fast-paced, remote environment.
• Customer service orientation with the ability to handle inquiries and grievances professionally.

Responsabilités

• Evaluate and authorize Medicaid prior authorization requests received by telephone using established clinical criteria.
• Determine the appropriateness of medications based on client clinical guidelines and coverage rules.
• Communicate prior authorization decisions to physicians, physician office staff, medical management staff, and pharmacists in a clear and professional manner.
• Document all prior authorization outcomes accurately and completely in the pharmacy system.
• Explain prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to prescribers and other healthcare professionals.
• Escalate requests to a pharmacist when a case requires extensive clinical review or when a denial is indicated, following clearly written step-by-step procedures.
• Document physician and client inquiries and grievances and provide timely verbal or written results to clients, prescribers, providers, and management.
• Work in the fax queue as needed, clinically reviewing coverage determinations for medications received via fax with strong attention to detail.

Connaissances

Pharmacy technician registration

PTCB or NHA certification

Prior authorization experience

Data entry accuracy

Strong communication

Remote work capability

Formation

High school diploma or GED

Description du poste

Actalent is seeking a Fully Remote Certified Pharmacy Technician to evaluate and authorize Medicaid prior authorization requests in a high-volume call center. The role focuses on clinical appropriateness using established criteria, documenting outcomes, and communicating decisions to healthcare professionals.

Candidates must have a high school diploma or GED, active state registration, PTCB/NHA certification, and 1+ year experience in a retail or call center pharmacy environment.