Remote Prior Authorization Pharmacy Technician

Capital Rx Inc.; New York (NY); Remote; USD 50,000 - 60,000; Full time

Job summary

Judi Health is seeking a Pharmacy Technician to support prior authorization requests and pharmacist reviews in a remote US-based role. You will validate prescriber and member information, guide reviews with clinical guidelines, and liaise with providers to gather necessary data.

This position emphasizes accurate claims analysis, proactive outreach, HIPAA compliance, and high-volume, metric-driven performance.

Qualifications

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting.
• Experience handling prior authorization requests/understanding of prior authorization requirements.
• National Certified Pharmacy Technician (CPhT) license is required.
• High school diploma or the equivalent; Associate's or bachelor's degree is preferred.

Responsibilities

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
• Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review.
• Proactively obtain clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Identify, document, and elevate provider concerns to the appropriate internal team including various members of the Prior Authorization Team.
• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
• Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies.
• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment

Skills

Pharmacy Technician

Prior Authorization

Communication

Remote Work

Multitasking

Education

CPhT License

HS Diploma

AA/BA Preferred

Job description

Judi Health is seeking a Pharmacy Technician to support prior authorization requests and pharmacist reviews in a remote US-based role. You will validate prescriber and member information, guide reviews with clinical guidelines, and liaise with providers to gather necessary data.

This position emphasizes accurate claims analysis, proactive outreach, HIPAA compliance, and high-volume, metric-driven performance.