Senior Pharmacy Technician, Utilization Management

AffirmedRx; United States; À distance; USD 34 000 - 55 000; Plein temps

Résumé du poste

AffirmedRx is seeking a non-clinical UM administrator to handle prior authorization reviews and act as a liaison among providers, pharmacies, members, and internal teams. The role focuses on timely authorizations and accurate record-keeping in UM systems.

The ideal candidate holds a health-related bachelor’s degree with 5+ years as a pharmacy technician, including UM experience, and strong data entry, documentation, and cross-functional collaboration skills.

Qualifications

• Bachelor’s degree in a health or related field.
• 5+ years of pharmacy technician experience, with at least 3 years in UM or related operations.
• Experience with prior authorization processes and UM workflows.
• Strong data entry, documentation, and communication skills.
• Ability to work cross-functionally and coach junior staff.
• Knowledge of HIPAA and regulatory requirements in a payer or health plan setting.

Responsabilités

• Receive, process, and conduct non-clinical review of prior authorization requests.
• Verify member eligibility, benefit coverage, and administrative details.
• Enter and maintain authorization records in UM and related systems.
• Assess submissions for completeness and elevate to a pharmacist when needed.
• Prepare cases for pharmacist review and communicate status to providers and members.
• Monitor work queues, support appeals, audits, and regulatory activities.

Connaissances

Data entry

Documentation

Communication

Cross-functional collaboration

Coaching junior staff

Formation

Bachelor’s degree in a health or related field

Description du poste

About the role

AffirmedRx is a pharmacy benefit manager focused on clarity and trust in health care outcomes. This role owns the non-clinical administration of utilization management programs, handling prior authorization processes and acting as a liaison among providers, pharmacies, members, and internal teams to ensure timely authorizations.

What you'll do

• Receive, process, and conduct non-clinical review of prior authorization requests
• Verify member eligibility, benefit coverage, and administrative details
• Enter and maintain authorization records in UM and related systems
• Assess submissions for completeness and elevate to a pharmacist when needed
• Prepare cases for pharmacist review and communicate status to providers and members
• Monitor work queues, support appeals, audits, and regulatory activities

What they're looking for

• Bachelor’s degree in a health or related field
• 5+ years of pharmacy technician experience with at least 3 years in UM or related operations
• Experience with prior authorization processes and UM workflows
• Strong data entry, documentation, and communication skills
• Ability to work cross-functionally and coach junior staff
• Knowledge of HIPAA and regulatory requirements in a payer or health plan setting

For applicants in Nigeria

• Location is listed as Remote; the listing does not specify a Nigeria-specific hiring restriction
• The listing does not state a required timezone; confirm during interview
• The listing does not specify contractor vs employee arrangements
• The listing does not provide pay currency or range; confirm compensation details with the employer
• The listing does not mention visa or work-authorization notes; confirm eligibility if applicable