Senior Pharmacy Technician – Utilization Management Lead

AffirmedRx, PBC; United States; Remote; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

Remote work

Job summary

AffirmedRx is seeking a Senior Pharmacy Technician, Utilization Management to lead non-clinical UM processes. You will manage prior authorization workflows, verify eligibility, maintain records, and coordinate with providers and pharmacies to ensure timely authorizations while maintaining HIPAA compliance.

The role emphasizes leadership in day-to-day UM operations, training, quality oversight, and acting as a UM subject-matter expert, with remote work accommodations and willingness to travel as

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Pharmacy, Health Sciences, or a related field
• 5+ years of pharmacy technician experience, including at least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations
• Active pharmacy technician registration, licensure, or other credential required by the state(s) in which the employee performs services
• Prior experience in a senior technician, trainer, quality reviewer, or workflow coordinator capacity
• Experience supporting operational configuration, user acceptance testing, validation, implementation, or maintenance of prior authorization or UM technology platforms
• Experience supporting pharmacy benefit configuration, formulary changes, clinical program implementation, audits, or process-improvement initiatives
• Familiarity with NCQA, URAC, ERISA, state-specific, or other applicable utilization management and pharmacy benefit requirements
• Demonstrated experience training, mentoring, coaching, or coordinating the work of others
• Working knowledge of pharmacy prior authorization operations, pharmacy benefits, formulary management, exception processing, and appeals support
• Experience using utilization management platforms, pharmacy claims systems, and Microsoft Office applications
• Strong analytical, organizational, written and verbal communication, customer service, and problem-solving skills
• Ability to exercise judgment and discretion to resolve ambiguous or non-standard operational situations, and to recognize and elevate matters that require pharmacist review
• Demonstrated ability to exercise discretion and independent judgment in resolving operational matters of significance without prior approval
• Ability to manage multiple priorities, meet turnaround-time expectations, and maintain accuracy and attention to detail in a fast-paced environment
• Ability to work independently and collaboratively across clinical, operational, and technical teams
• Ability to maintain confidentiality and appropriately handle protected health information (PHI)
• Dedicated, private, and secure remote work environment that meets organizational requirements
• Willingness to travel 10-20%

Responsibilities

• Receive, process, and conduct non-clinical review of pharmacy prior authorization requests and supporting documentation
• Verify member eligibility, benefit coverage, authorization requirements, and applicable administrative information
• Enter, update, and maintain authorization records within UM, pharmacy claims, and related systems
• Obtain and document required information from providers, pharmacies, members, and other health care entities
• Assess incoming prior authorization submissions for completeness and route them to the appropriate level of review, escalating to a pharmacist when standard criteria, business rules, or established workflows do not clearly apply
• Prepare cases for pharmacist review and elevate requests requiring clinical judgment or a coverage determination in accordance with established workflows
• Communicate authorization status, requests for additional information, and other non-clinical case information to providers, pharmacies, and members, as appropriate
• Maintain accurate and complete documentation of case activities, communications, and outcomes
• Monitor assigned work queues and prioritize requests to support compliance with applicable turnaround-time and notification requirements
• Support appeals, reconsiderations, audits, quality initiatives, and regulatory or accreditation activities within the technician scope of responsibility
• Protect confidential information and comply with HIPAA and all applicable federal, state, client, contractual, and organizational requirements
• Operational Support and Coordination: Serve as a subject matter expert for UM technicians regarding workflows, policies, procedures, benefit administration, and system functionality
• Determine and manage workload distribution, queue prioritization, and coordination of urgent or time-sensitive requests across the UM technician team
• Monitor workload, turnaround times, productivity, quality, and other operational performance indicators; analyze trends or barriers and determine and implement corrective action, reporting outcomes to UM leadership
• Conduct quality reviews, identify recurring errors or workflow gaps, and provide coaching, feedback, and training to support accuracy, consistency, and compliance
• Support onboarding, mentoring, and ongoing development of new and existing UM technicians
• Develop, maintain and operationalize technician workflows, standard operating procedures, job aids, and training materials.
• Investigate and resolve non-clinical authorization issues, workflow conflicts, and provider or pharmacy inquiries, exercising discretion to determine the appropriate resolution
• Serve as a day-to-day resource for UM technicians by providing guidance on established workflows, priorities, and non-clinical operational questions; resolve non-clinical matters and elevate clinical or coverage questions to a pharmacist and operational concerns to UM leadership
• Provide backup support for designated operational leadership functions, as assigned
• Technology, Implementation, and Process Improvement: Serve as a super-user for the prior authorization technology platform and related UM systems
• Lead operational configuration, user acceptance testing, validation, implementation, and ongoing maintenance of prior authorization technology platforms
• Lead implementation of formulary updates, utilization management programs, system enhancements, and client-specific workflows
• Collaborate with pharmacists, UM leadership, operations, clinical configuration, claims, and technology teams to investigate and resolve workflow or system issues
• Identify opportunities to improve efficiency, accuracy, service, and the user experience; assist with development and implementation of sustainable process improvements
• Support audit preparation, accreditation readiness, corrective-action activities, and compliance initiatives

Skills

UM operations

Prior authorization

Pharmacy benefits

Workflow coordination

Education

Bachelor’s degree in Healthcare Administration

Bachelor’s degree in Business Administration

Pharmacy

Tools

Prior authorization platforms

UM systems

Microsoft Office

Job description

AffirmedRx is seeking a Senior Pharmacy Technician, Utilization Management to lead non-clinical UM processes. You will manage prior authorization workflows, verify eligibility, maintain records, and coordinate with providers and pharmacies to ensure timely authorizations while maintaining HIPAA compliance.

The role emphasizes leadership in day-to-day UM operations, training, quality oversight, and acting as a UM subject-matter expert, with remote work accommodations and willingness to travel as