prior authorization technician

Shields Health Solutions

<div>Patient Support Advocate
Job Purpose:

Within this role, this person will provide patient care by removing the barriers to medication access. Working with insurance companies and clinician offices to facilitate approval of medications through prior authorizations. Working with patients and a variety of funding sources such as foundations, or directly through manufactures to obtain financial assistance for high dollar co-pays. Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims, refill medications, and increase adherence in patients. 


Job Duties:
<ul>
<li>Directly communicate with insurance companies to facilitate the approval of medications.</li>
<li>Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up.</li>
<li>Effectively communicate across databases, electronic medical records and emails to document patient concerns, prior authorization status, and financial assistance needs.</li>
<li>Review prescriptions with doctors' offices to ensure optimal care of the patient.</li>
<li>Keep complete and accurate records of patient communications.</li>
<li>Assist patients in the management of their pharmacy insurance claims.</li>
<li>Work closely with pharmacists and pharmacy liaisons to provide an integrated approach quality patient care.</li>
<li>Communicate directly with patients over the phone to assist them in all aspects of medication compliance.</li>
<li>Research and investigate information to enable strategic decision-making by others.</li>
<li>Manage, organize, and update relevant data using database applications.</li>
<li>Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards.</li>
<li>Identify trends, resolve problems; recommend improvements; implement change.</li>
<li>Actively participate in process improvement initiatives.</li>
<li>Act as a value-added business partner to stakeholders throughout the organization.</li>
<li>Protect organization's value by keeping information confidential.</li>
<li>Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.</li>
<li>Minimal in or out of state travel may be required.</li>
<li>Perform other duties as assigned.</li></ul> 


Experience/ Education:

Required Licensure/Certification: We are seeking experienced pharmacy technicians who are state registered, or state certified as a pharmacy technician. Nationally certified as a CPhT or equivalent is strongly preferred but not required.
<ul><li>If the candidate's state of residence does not have a state registration available, then the National certification is required at time of hire. Should additional licensure need to be obtained, the applicant will commit to obtaining the required licensure within a mutually agreed upon timeframe. Continued employment is contingent upon meeting these requirements.</li></ul>

Years of Experience: Required 1+ years as a Pharmacy Technician

Education: High school diploma or GED required<div>
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Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.</div></div>

Remote Prior Authorization Pharmacy Technician

Molina Healthcare

Molina Healthcare is hiring for remote Certified Pharmacy Technicians. These roles will be in our Prior Authorization department. You will review prior auth requests that are submitted.
 
Schedules for these role will vary between 7am to 10pm EST.
 
Qualified candidates must have either PTCB certification or Pharmacy Tech State license. High preference for those who are self-starters and go-getters. Must have above average computer skills along with a high level of communication skills both written and verbal.
 
As a Pharmacy Tech here at Molina, you will provide support for pharmacy technician activities. You will also contribute to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
 
Essential Job Duties
 
Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests.
 
Accurately enters approvals or denials of requests.
 
Facilitates prior authorization requests within established pharmacy policies and procedures.
 
Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices.
 
Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership.
 
Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues.
 
Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed.
 
Required Qualifications
 
At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience.
 
Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.
 
Ability to abide by Molina policies.
 
Ability to maintain attendance to support required quality and quantity of work.
 
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
 
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
 
Excellent verbal and written communication skills.
 
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
 
#PJPharm3
 
#LI-AC1
 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $12.19 - $26.42 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Pharmacy Technician CPhT (Remote)

Ventegra

Job PurposeVentegra is a rapidly growing, fast paced, innovative virtual company. As part of Ventegra, the Pharmacy Technician I, provide daily operational support to the Pharmacist and Customer Care Specialist related to prior authorizations. The Pharmacy Technician 1 has the clinical skills to review and evaluate the appropriateness and medical necessity of medications based on established criteria. The Pharmacy Technician I, promotes and supports quality pharmacy services.Duties and Responsibilities<ul><li>Maintain an accurate and current knowledge of required criteria, training materials, systems, prior authorization processes and plan benefits</li><li>Accurately enter authorizations approvals in the claims processing system</li><li>Accurately document case notes relate to member&rsquo;s medications as required in the prior authorization review process</li><li>Review incoming fax requests for medications requiring a prior authorization, while ensuring an elevated level of customer service and maximizing productivity. Requests additional information from providers as needed to properly evaluate the request</li><li>Assist Clinical Pharmacist by providing accurate documentation and clear clinical notes related to a prior authorization request</li><li>Provide clinical review and determinations of prior authorization in keeping with legal and contractual requirements, including turnaround times and service level agreements</li><li>Escalate issues through the appropriate channel of management to ensure patient has access to medications</li><li>Effectively manages and prioritize prior authorization requests based on turn-around times</li><li>Effectively communicates both internally and externally to enhance the effectiveness of pharmacy prior authorization process and ensure the needs of the members and clients are met</li><li>Must maintain the highest level of member confidentiality and adheres to all company policies regarding confidentiality and HIPAA</li><li>Assist in the processing of telephonic prior authorizations request from physicians using established criteria and guideline</li><li>Assist with other duties and responsible as assign by management based on department needs</li></ul>Required Skills and Abilities<ul><li>Excellent verbal and written communication skills</li><li>Ability to focus and prioritize</li><li>Accurate and detail oriented</li><li>Ability to multi-task with minimal direction</li><li>Flexibility and ability to adapt to changes and updates to processes and protocols</li><li>Demonstrate problem-solving skills, information gathering, research, alternatives analysis, applying creative solutions to unique and/or immediate issues</li><li>High volume call center experience a plus</li><li>Experience processing in pharmacy prior authorization request using medication criteria</li><li>Proficient in Microsoft Office programs (Word, Excel, Outlook, etc.)</li><li>Dependability and good attendance are an essential function of the job</li></ul>Education and Experience<ul><li>High School Diploma or GED equivalent.</li><li>Current Pharmacy Technician License required; Certified Pharmacy Technician License (CPhT) required</li><li>1-year experience as a Pharmacy Prior Authorization Technician or minimum 1-year experience as a Ventegra Customer Care Specialist (CCS) with Technician Certification (CPhT required)</li></ul>Work environment requirementsA home office setting, free from noise and distraction allowing you to interact professionally both externally and internally.Pay: $20.00 per hourWork Location: Remote

Clinical Pharmacy Technician I

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary<ul><li>Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews.</li><li>Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation.</li><li>Reviews potential prior authorization denial language to ensure NCQA requirements are met.</li><li>Follows prior authorization workflow, policies, and procedures during the course of the workday.</li><li>Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions.</li><li>Maintains a balance of productivity, quality and timeliness of work.</li><li>Participates in training and continuing education as required.</li><li>Participates in team/departmental meetings as required.</li><li>Excellent attendance is a must.</li><li>Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions.</li><li>Successful pharmacy technicians will possess good written and verbal communication skills.</li></ul> 
 
<ul><li>Hours of operation for Aetna Pharmacy Prior Authorization are between 5:00am to 8:30pm (may vary by time zone). Pharmacy Technicians work 8 hours shifts that may fall in between these hours of operations. Overnight shifts may also be available, but not guaranteed. Work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Part time positions are not available. Position requires the ability to work extended hours when necessary.</li><li>Rotating weekend schedule may be required.</li></ul> 
 
<ul><li>Candidate must have their own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord).</li><li>Candidate must also have a secure workspace/office in their home.</li><li>Candidate must have high level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens).</li></ul><div> 
Required Qualifications 
<ul><li>National Pharmacy Technician certification and Arizona or applicable state Pharmacy Technician license, current and in good standing, are required and must be maintained</li><li>Between 1-5+ years of Pharmacy Prior Authorization processing experience</li><li>Ability to Multi-task and prioritize work</li><li>Ability to adjust based on business or department needs</li><li>Good organization skills</li></ul> 

Preferred Qualifications</div>
Retail or Hospital experience 
Managed Care or Medicaid experience 
AS400 experience 
Proficiency in using computerized resources and software applications 
Proficiency with Microsoft applications (Excel, Word, and Outlook) 
Knowledge in pharmacy practices, procedures, and ability to read and understand clinical information 
Working knowledge of drug dosage forms, drug strength, generic and brand name equivalent. 
Education
High School diploma, G.E.D.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $35.29
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 04/25/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Pharmacy Technician - Prior Authorizations - Work From Home

Community Health Care

<div>Community Health Care is a leading non-profit organization that offers quality health care to underserved patients in Pierce County. We provide comprehensive family practice care, including medical, dental, pharmacy, and behavioral health services in our seven clinics. We seek to continuously improve our commitment and service to our patients and community
We want you to join us in our mission to provide the highest quality healthcare with compassionate and accessible service for all
We offer a competitive benefits package including Medical, Dental, Paid Vacation, Sick Leave, 12 Paid Holidays, Life Insurance, Flexible Spending Account, Continuing Education, Employee Assistant Program and more!
We are looking for a Pharmacy Technician Prior Authorization Specialist to join our team. In this role, you'll be responsible for managing and processing prior authorization (PA) requests, ensuring accuracy, efficiency, and compliance with client standards and turnaround times.
Responsibilities<ul><li>
Accurately enter non-clinical and structured clinical data into Nextgen and other applications</li><li>
Document all PA outcomes approvals or denials</li><li>
Complete PA requests within established client turnaround times</li><li>
Review medication formularies and evaluate tried-and-failed alternatives</li><li>
Follow defined guidelines separating PA processing and clinical decisions</li><li>
Research and resolve PA issues using phone and written inquiries to providers, pharmacies, members, or SMEs</li><li>
Coordinate notifications and follow-up regarding pending requests and PA determinations</li><li>
Make outbound calls to update or obtain PA information</li><li>
Partner with clinical teams on PA requirements and special projects</li><li>
Provide staff support during high-volume PA periods</li><li>
Maintain PA and member confidentiality; ensure proper document handling</li><li>
Establish strong rapport with colleagues, providers, clients, and patients</li><li>
Contribute to Quality Assurance Improvement initiatives</li><li>
Serve as SME and mentor for nurses and provider teams</li><li>
Ensure provider access to managed-care formularies</li><li>
Troubleshoot PA issues and educate staff on compliance</li><li>
Act as Pharmacy Technician backup as needed</li><li>
Perform other duties as assigned</li></ul>
We have a $1,500 Sign on Bonus available for this position.<ul><li>
Current Pharmacy Technician License Required</li><li>
High School Education or GED</li><li>
One year Pharmacy Technician related experience and or training</li></ul>
We encourage anyone with a relevant combination of education and experience to apply</div>

Pharmacy Technician - Prior Authorization Specialist

Gainwell Technologies

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Review Prior Authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and current clinical guidelines
 </li>
 <li>
 Support peer-to-peer discussions with medical providers regarding Prior Authorization reviews
 </li>
 <li>
 Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting
 </li>
 <li>
 Contribute to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians; available for consultation on pharmacy-related questions and issues within the organization
 </li>
 <li>
 Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders
 </li>
 <li>
 Uphold the clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists to provide pharmacy expertise
 </li>
 <li>
 Collaborate internally with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends or areas to explore, with the intent of identifying new drugs and therapeutic classes requiring utilization management
 </li>
 <li>
 Other duties as assigned
 </li>
 <li>
 Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 PharmD or B.S. in Pharmacy with relevant specialty background
 </li>
 <li>
 Registered Pharmacist with an unrestricted state license (Texas Pharmacist License preferred but not required)
 </li>
 <li>
 4 years of experience in clinical pharmacy
 </li>
 <li>
 Strong verbal and written communication skills
 </li>
 <li>
 Highly skilled in Microsoft Office products and able to quickly learn proprietary systems
 </li>
 <li>
 Expected working hours: 10:00 am to 7:00 om CST, including select holidays and occasional weekend on-call coverage
 
 
 </li>
 </ul>
 
 Basic Qualifications
 
 
 
 <ul>
 <li>
 Experience in coordinating and collaborating with work teams preferred
 </li>
 <li>
 Ability to perform clinical reviews using relevant compendia and clinical trial data
 </li>
 <li>
 Managed care and/or prior authorization experience is a plus
 </li>
 <li>
 Strong research and implementation skills in practical settings
 </li>
 <li>
 Analytical skills that translate into practical and pragmatic recommendations
 </li>
 <li>
 Strong team orientation with respect for all members
 </li>
 <li>
 Strong interpersonal skills that support effective consultation and collaboration with internal and external stakeholders who do not directly report to this role
 </li>
 <li>
 Prior call center experience preferred
 
 
 </li>
 </ul>
 
 Work Environment
 
 
 
 <ul>
 <li>
 Work from home
 </li>
 <li>
 Reliable high-speed internet connectivity required
 </li>
 <li>
 A dedicated, private (HIPAA-compliant) workspace without distractions
 
 
 </li>
 </ul>
 Applications will be accepted through April 28, 2026.
 
 
 The pay range for this position is $90,000.00 - $129,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
 
 
 We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
 
 
 
 Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
</div>

Prior Authorization Pharmacist - Texas Medicaid (Remote)

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