Remote Pharmacy Prior Authorization Specialist

Actalent; St. Louis (MO); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision insurance

401(k) Retirement Plan

Life Insurance

Job summary

Actalent is seeking a Pharmacy Technician for Prior Authorization in a fully remote role. You will review coverage determinations for government-sponsored plans, manage a high-volume queue, verify eligibility, and gather clinical information.

Prior authorization and remote work experience are highly preferred. The position starts as a 6-month contract with potential extension or permanent hire, based on performance.

Qualifications

• Prior authorization experience is required.
• 2+ years of pharmacy technician experience in a managed care or prior authorization setting.
• NHA or PTCB certification preferred but not required.
• Previous remote environment experience highly preferred, with strong self management skills.
• Strong communication skills when interacting with providers and members.
• Ability to work efficiently in a fastpaced, highvolume queue.
• Comfortable navigating PBM systems and documenting case decisions accurately.

Responsibilities

• Coverage Determination Review: Evaluate prior authorization requests submitted by providers to determine if criteria are met for approval.
• Case Triage: Track, sort, and route incoming requests; identify when pharmacist review is required.
• Clinical Information Gathering: Contact prescribers to obtain missing details needed to complete a determination.
• Decision Processing: Approve requests when criteria are clearly met; escalate specialty drug cases when needed.
• Documentation: Enter decisions into the PBM system with accurate notes.
• Provider & Member Communication: Notify physicians, providers, and members of determination outcomes.
• Client Support: Respond to inquiries regarding authorization approvals and PBM online applications.
• Information Follow-Up: Reach out to providers for additional details to finalize reviews.

Skills

Prior authorization experience

Pharmacy technician experience

Remote work experience

Communication skills

Fast-paced environment

Education

PTCB/NHA certification (preferred)

Tools

PBM systems

Job description

Actalent is seeking a Pharmacy Technician for Prior Authorization in a fully remote role. You will review coverage determinations for government-sponsored plans, manage a high-volume queue, verify eligibility, and gather clinical information.

Prior authorization and remote work experience are highly preferred. The position starts as a 6-month contract with potential extension or permanent hire, based on performance.