Remote CPhT - Medicaid Pharmacy Programs

Gainwell Technologies LLC; Adams (MA); Remote; USD 39,000 - 52,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with match

Flexible vacation policy

Educational assistance

Job summary

Gainwell Technologies LLC is seeking a Certified Pharmacy Technician (CPhT) for a fully remote role supporting Rhode Island Medicaid and other state programs. You will handle pharmacy claims, prior authorizations, provider support, eligibility, formulary, and program operations while collaborating with state agencies, providers, and internal teams.

This role requires a valid CPhT credential and 2+ years of related experience, with strong problem-solving and communication skills.

Qualifications

• Active Certified Pharmacy Technician credential (PTCB/CPhT, ExCPT, or equivalent) required.
• Two or more years of pharmacy technician experience, preferably within managed care, PBM, Medicaid, or related healthcare.
• Experience with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider, or pharmacy support.
• Experience with POS claims, HCPCS, provider enrollment, formularies, eligibility, or related pharmacy program operations is highly desirable.
• Strong communication, research, problem-solving, computer, and organizational skills with the ability to navigate multiple systems in a fast-paced remote environment.

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

Pharmacy tech experience

POS/HCPCS experience

Research & problem solving

Education

CPhT credential

Job description

Gainwell Technologies LLC is seeking a Certified Pharmacy Technician (CPhT) for a fully remote role supporting Rhode Island Medicaid and other state programs. You will handle pharmacy claims, prior authorizations, provider support, eligibility, formulary, and program operations while collaborating with state agencies, providers, and internal teams.

This role requires a valid CPhT credential and 2+ years of related experience, with strong problem-solving and communication skills.