Senior Clinical Operations Technician (UM & Formulary)

Prime Therapeutics; Tallahassee (FL); On-site; USD 26,000 - 40,000; Full time

Job summary

Prime Therapeutics is hiring a Commercial Sr Technician in Tallahassee, FL. You will process and track formulary exceptions, prior authorizations, quantity exceptions, and brand overrides for delegated utilization management products and services.

The role supports cross-functional teams, coordinates with onshore and offshore staff, and ensures accurate documentation and timely resolutions while maintaining compliance with clinical and plan requirements.

Qualifications

• High school diploma or GED required.
• 2+ years of pharmacy or healthcare delivery experience preferred.
• Must be eligible to work in the United States without visa sponsorship.

Responsibilities

• Serve as point of contact for internal reviewers, provide guidance and support for complex cases.
• Respond to escalated calls from the Contact Center and providers with accurate information and documentation.
• Review clinical criteria to determine approval eligibility and update prior authorizations and denials.
• Monitor inboxes/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 clinical information to Pharmacists and Physicians to support decisions.

Skills

Pharmacy experience

Health care delivery

Education

High school diploma

Associate's degree

Tools

Microsoft Office

Internet

Email

Job description

Prime Therapeutics is hiring a Commercial Sr Technician in Tallahassee, FL. You will process and track formulary exceptions, prior authorizations, quantity exceptions, and brand overrides for delegated utilization management products and services.

The role supports cross-functional teams, coordinates with onshore and offshore staff, and ensures accurate documentation and timely resolutions while maintaining compliance with clinical and plan requirements.