Senior Pharmacy UM & Prior Authorization Specialist

Prime Therapeutics; Columbia (SC); On-site; USD 26,000 - 40,000; Full time

Job summary

Prime Therapeutics is seeking a Commercial Senior Technician in Columbia, SC to process and track complex formulary exceptions, prior authorizations, and brand overrides for delegated UM products. The role acts as a technical resource for client processes and complex case research.

The position requires a high school diploma, 2 years of pharmacy or healthcare delivery experience, and eligibility to work in the United States without visa sponsorship.

Qualifications

• High school diploma or GED.
• 2 years of pharmacy or health care delivery experience.
• Eligible to work in the United States without visa sponsorship.
• Associate's degree preferred.
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) preferred.
• 1 year of PBM experience preferred.
• Previous customer service experience preferred.

Responsibilities

• Serve as a point of contact for internal reviewers with guidance and case support.
• Respond to escalated calls from the Contact Center and providers with accurate information and resolutions.
• Review clinical criteria to determine approval eligibility and update authorizations in UM systems.
• Monitor and manage assigned inboxes and work queues to meet turnaround requirements.
• Conduct outreach to pharmacies and physician offices to obtain required information for UM requests.
• Provide complete clinical information to Pharmacists and Physicians to support decisions.

Education

High School Diploma or GED

Associate's degree

Tools

Microsoft Office

PC knowledge

Email

Job description

Prime Therapeutics is seeking a Commercial Senior Technician in Columbia, SC to process and track complex formulary exceptions, prior authorizations, and brand overrides for delegated UM products. The role acts as a technical resource for client processes and complex case research.

The position requires a high school diploma, 2 years of pharmacy or healthcare delivery experience, and eligibility to work in the United States without visa sponsorship.