Remote-Eligible Pharmacy Prior Authorization Tech

Univera Healthcare; United States; Remote; USD 29,000 - 46,000; Full time

Benefits offered by this job

Remote work possibility

Paid holidays

Wellness program

Job summary

Univera Healthcare is seeking a Managed Care Pharmacy Technician to support pharmacy benefits programs, answer live calls from members and providers, and assist with prior authorization activities under supervision of a pharmacist.

The role involves processing medical exception requests using clinical algorithms, monitoring formulary tools, and collaborating with internal and external customers to resolve issues in the pharmacy benefit system. Remote work may be possible on a case-by-case basis.

Qualifications

• High school diploma with >=2 years in health-related field; associates degree preferred.
• Pharmacy Technician certification (CPhT) or equivalent; LPN/Medical Assistant background preferred.
• Proficient with MS Office; strong verbal and written communication skills.

Responsibilities

• Review medical exception requests using pharmacist-created algorithms.
• Evaluate prior authorization requests against criteria to determine approval.
• Assist with data entry and monitoring of member profiles for PA requests and ad-hoc reports.
• Provide information to physicians and pharmacists regarding pharmacy initiatives over the phone.
• Provide real-time certification for prescription medications (vacation supplies, duplication overrides, package size).
• Implement formulary utilization tools (PA, quantity limits, step therapy, dose optimization, age/gender restrictions).
• Collaborate with internal/external customers to resolve system issues related to pharmacy benefits.
• Research and resolve issues related to mail-order or specialty pharmacy and Facets claims processing.
• Provide backup coverage for Pharmacy Benefits Team phone queue; support internal/external inquiries.

Skills

Customer service

Verbal and written communication

Problem solving

Teamwork

On-call flexibility

Education

CPhT certification

Associates degree preferred

High school diploma

LPN background

Medical Assistant background

Tools

Facets system

Microsoft Office

Job description

Univera Healthcare is seeking a Managed Care Pharmacy Technician to support pharmacy benefits programs, answer live calls from members and providers, and assist with prior authorization activities under supervision of a pharmacist.

The role involves processing medical exception requests using clinical algorithms, monitoring formulary tools, and collaborating with internal and external customers to resolve issues in the pharmacy benefit system. Remote work may be possible on a case-by-case basis.