Remote CPhT — Medicaid & PBM Pharmacy Specialist

Gainwell Technologies LLC; Ohio; Remote; USD 39,000 - 52,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) match

Educational assistance

Generous vacation policy

Job summary

Gainwell Technologies is seeking a Certified Pharmacy Technician (CPhT) to support Rhode Island Medicaid and other state programs remotely. You will handle pharmacy claims, prior authorizations, and provider support while researching issues to ensure accurate program operations.

Ideal candidates have a CPhT credential and 2+ years in managed care or PBM settings, with strong communication and problem-solving skills. This is a full-time remote role within the United States.

Qualifications

• Active Certified Pharmacy Technician credential (PTCB/CPhT, ExCPT, or equivalent) required.
• Two or more years of relevant pharmacy technician experience, preferably within managed care, PBM, health insurance, Medicaid, or related healthcare environment.
• Experience with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider, or pharmacy support.

Responsibilities

• Maintain day-to-day relationships with state agency personnel while supporting eligibility updates, reporting, formulary activities, and prior authorization support.
• Support state agency pharmacy programs, policies, processes, and reporting requirements, including POS and HCPCS adjudication related to medication prior authorizations.
• Review, research, and process pharmacy prior authorization requests in accordance with established criteria, policies, regulatory requirements, FDA guidance, and service-level expectations.
• Research and resolve program, member, provider, and pharmacy inquiries, including provider enrollment questions involving limited distribution drugs, while documenting activity accurately.
• Partner with internal departments on pharmacy initiatives, provide pharmacy program subject-matter expertise, and help identify opportunities to improve quality and operational performance.

Skills

Communication

Research

Problem-solving

Computer skills

Organization

Education

Certified Pharmacy Technician credential (PTCB/CPhT, ExCPT, or equivalent)

Tools

Pharmacy software systems

Job description

Gainwell Technologies is seeking a Certified Pharmacy Technician (CPhT) to support Rhode Island Medicaid and other state programs remotely. You will handle pharmacy claims, prior authorizations, and provider support while researching issues to ensure accurate program operations.

Ideal candidates have a CPhT credential and 2+ years in managed care or PBM settings, with strong communication and problem-solving skills. This is a full-time remote role within the United States.