Senior Clinical Operations Technician – PBM Solutions

PRIME Therapeutics; United States; Remote; USD 23,000 - 40,000; Full time

Job summary

Prime Therapeutics LLC is seeking a Senior Clinical Operations Technician to process and track complex UM requests—including formulary exceptions, prior authorizations, quantity exceptions and brand overrides—for delegated UM products and services.

The role serves as a technical resource for client-specific processes and complex case research, coordinating with internal reviewers, pharmacists and physicians to support accurate approvals, denials and documentation.

Qualifications

• High school diploma or equivalent required.
• 2 years of pharmacy experience or health care delivery experience.
• Eligible to work in the United States without visa sponsorship.

Responsibilities

• Serve as a point of contact for internal reviewers and provide guidance on case-specific questions and complex scenarios.
• Respond to escalated calls from the Contact Center and providers with accurate information and proper documentation.
• Review clinical criteria to determine approval eligibility and update prior authorizations, approvals, or denials in UM systems.
• Monitor and manage assigned inboxes and work queues to meet client turnaround requirements and resolve complex cases.
• Conduct outreach to pharmacies and physician offices to obtain required information for UM requests.
• Provide relevant clinical information to Pharmacists and Physicians to support clinical decision-making.
• Other duties as assigned.

Skills

Attention to detail

Communication skills

Problem-solving

Team collaboration

Education

High school diploma

Associate's degree

PBM Certification

Tools

Microsoft Office

Job description

Prime Therapeutics LLC is seeking a Senior Clinical Operations Technician to process and track complex UM requests—including formulary exceptions, prior authorizations, quantity exceptions and brand overrides—for delegated UM products and services.

The role serves as a technical resource for client-specific processes and complex case research, coordinating with internal reviewers, pharmacists and physicians to support accurate approvals, denials and documentation.