Qureos Mentor

The Judge Group

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 Pharmacy Technician (Remote &ndash; PA, DE, NJ Only)
 
 
 
 
 Schedule:
 
 M&ndash;F, Day Shift
 
 
 
 
 
 
 Key Responsibilities
 
 
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 Review medical records and determine medical necessity using clinical guidelines.
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 Use Medical Policy, Care Management Policy, MicroMedex, and other references to assess appropriateness.
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 Coordinate approved medication authorizations with specialty pharmacy vendors.
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 Escalate cases that do not meet criteria to the Clinical Care Coordinator.
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 Confirm benefit coverage and ensure compliance with regulations.
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 Requirements
 
 
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 Certified Pharmacy Technician (CPhT)
 
 &mdash; required
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 2+ years
 
 Utilization Review or Utilization Management (preferred)
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 Strong clinical judgment, communication, and documentation skills
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 Must reside in
 
 PA, DE, or NJ
 
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 </ul>
 
 
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Pharmacy Technician

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 Pharmacy Technician &ndash; Remote (Tri‑State Region: PA, DE, NJ)
 
 
 Schedule: Monday&ndash;Friday, Day Shift
 
 
 Work Model: Remote (Candidate must reside in PA, DE, or NJ)
 
 
 
 
 
 About the Role
 
 
 We are seeking a detail‑oriented and clinically knowledgeable Pharmacy Technician to support medical necessity review and authorization processes. In this role, you will review patient medical records, evaluate clinical information, and make independent determinations using established medical criteria. You will collaborate with providers, ensure regulatory compliance, and maintain high standards for accuracy and documentation.
 
 
 This position requires strong critical‑thinking skills, familiarity with medical policies, and the ability to work independently in a fast‑paced environment.
 
 
 
 
 
 Key Responsibilities
 
 
 Clinical Review &amp; Case Evaluation
 
 
 
 
 
 Review medical records&mdash;including medical history, treatment plans, and progress notes&mdash;to assess medical necessity of requested services.
 
 
 Apply advanced clinical knowledge, judgment, and approved criteria to make case determinations.
 
 
 Utilize resources such as Care Management Policy, Medical Policy, MicroMedex, and electronic reference tools to support decisions.
 
 
 
 
 
 Provider Communication &amp; Care Coordination
 
 
 
 
 
 Contact servicing providers to clarify treatment plans, confirm clinical need, or request additional information.
 
 
 Notify ordering providers and Specialty Pharmacy vendors once authorizations are approved to ensure timely medication shipment.
 
 
 Review treatment plans with providers and confirm all required information for processing.
 
 
 
 
 
 Authorization &amp; Regulatory Compliance
 
 
 
 
 
 Independently authorize medically necessary services within the scope of policy.
 
 
 Refer cases that fall outside established criteria to a Clinical Care Coordinator for further evaluation.
 
 
 Validate that requested services are covered under the member&rsquo;s benefit plan.
 
 
 Ensure all utilization decisions adhere to federal, state, and accreditation regulations.
 
 
 
 
 
 Documentation &amp; Data Integrity
 
 
 
 
 
 Maintain complete, accurate documentation in accordance with Care Management and Coordination Policy.
 
 
 Perform timely and precise data entry to ensure system accuracy.
 
 
 Meet or exceed regulatory turnaround times and departmental productivity goals.
 
 
 
 
 
 
 
 
 Required Qualifications
 
 
 
 
 
 Pharmacy Technician experience in a clinical, utilization management, or medical review environment strongly preferred.
 
 
 Strong knowledge of medical terminology, pharmacy workflows, and clinical documentation.
 
 
 Ability to apply medical necessity criteria and interpret clinical records.
 
 
 Excellent communication and critical‑thinking skills.
 
 
 Must reside in Pennsylvania (PA), Delaware (DE), or New Jersey (NJ).
 
 
 
 
 
 
 
 
 Preferred Skills &amp; Attributes
 
 
 
 
 
 Experience working with medical policies, care management references, or clinical guidelines.
 
 
 Strong interpersonal skills and comfort interacting with healthcare providers.
 
 
 High attention to detail and commitment to accuracy.
 
 
 Ability to manage multiple priorities and meet tight deadlines in a structured environment.
 
 
 Familiarity with healthcare regulatory requirements.
 
 
 
 
 
 
 
 
 Work Environment
 
 
 
 
 
 Fully remote role supporting clinical and administrative processes.
 
 
 Requires independent decision‑making and consistent communication with internal teams and providers.
 
 
 Task‑driven position with clear workflow expectations and defined escalation paths.
 
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Pharmacy Technician

Pharmacy Technician