Remote CPhT: Medicaid Prior Authorization Expert

Actalent; Dallas (TX); Remote; USD 25,000 - 30,000; Part time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life insurance

Disability insurance

Health Spending Account (HSA)

Transportation benefits

PTO / Vacation

Job summary

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 requires active state registration and national certification (CPhT) and offers remote training, modern equipment, and potential contract extension after one year.

Responsibilities include evaluating requests, communicating decisions to prescribers, documenting outcomes, and escalating complex cases to a Pharmacist when needed.

Qualifications

• Active State Pharmacy Technician registration or license verified through the state Board of Pharmacy.
• National Pharmacy Technician Certification (CPhT) through PTCB or NHA with verifiable status.
• High School Diploma or GED.
• At least 1 year of experience in a retail or call center pharmacy environment (3+ years preferred).

Responsibilities

• Evaluate and authorize Medicaid prior authorization requests from prescribers via telephone following clinical criteria.
• Determine medication appropriateness based on guidelines and client criteria.
• Communicate PA decisions to physicians, office staff, and pharmacists clearly.
• Document PA outcomes accurately in the pharmacy system for compliant records.
• Explain PA criteria, coverage, and formulary alternatives to prescribers and staff.
• Escalate complex cases to a Pharmacist when needed per procedures.
• Record inquiries and outcomes, providing timely responses to stakeholders.
• Review and process coverage determinations for medications received via fax.
• Communicate coverage decisions within SLA timeframes.
• Multitask across multiple queues (fax, pending, oral notifications, failed faxes).
• Adapt to changing team needs and workflow priorities.

Education

Active State Pharmacy Technician Registration or License

National Pharmacy Technician Certification (CPhT)

High School Diploma or GED

Job description

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 requires active state registration and national certification (CPhT) and offers remote training, modern equipment, and potential contract extension after one year.

Responsibilities include evaluating requests, communicating decisions to prescribers, documenting outcomes, and escalating complex cases to a Pharmacist when needed.