Senior Clinical Operations Tech (Pharmacy UM)

Socket.dev; Home (WV); On-site; USD 26,000 - 40,000; Full time

Job summary

Prime Therapeutics LLC seeks a Commercial Sr Technician to process, communicate, document, and track complex UM requests including formulary exceptions and prior authorizations. You will serve as a technical resource for client-specific processes and research for complex cases.

The role requires strong attention to detail, effective communication, and the ability to collaborate across onshore and offshore teams. Some weekend or holiday coverage may be required.

Qualifications

• High school diploma or GED required.
• 1–2 years pharmacy or health care delivery experience.
• Associate's degree preferred; PBM experience a plus.
• PTCB or ExCPT certification preferred.

Responsibilities

• Serve as a point of contact for internal reviewers with guidance and case research responsibilities.
• Respond to escalated calls from the Contact Center and providers, ensuring proper documentation.
• Review clinical criteria to determine approval eligibility and update UM systems.
• Monitor inboxes and work queues to meet client turnaround requirements across multiple teams.
• Conduct outreach to pharmacies and physician offices to obtain information for UM requests.

Skills

Attention to detail

Communication skills

Problem-solving

Flexibility

Education

High school diploma or GED

Associate's degree

PTCB/ExCPT certification

Tools

Microsoft Office

Email & Internet use

Job description

Prime Therapeutics LLC seeks a Commercial Sr Technician to process, communicate, document, and track complex UM requests including formulary exceptions and prior authorizations. You will serve as a technical resource for client-specific processes and research for complex cases.

The role requires strong attention to detail, effective communication, and the ability to collaborate across onshore and offshore teams. Some weekend or holiday coverage may be required.