Remote Pharmacy TechnicianThis role focuses on supporting Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will start with intake of prior authorization requests and be trained to perform technical reviews, making clinical coverage determinations based on established criteria, SOPs, and insurance and medical documentation. The position combines detailed data entry, managed care pharmacy knowledge, and customer service over the phone to ensure patients receive timely and accurate decisions regarding their medications.
ResponsibilitiesProcess the intake of MedPharm prior authorization requests by accurately setting up prior authorizations in internal systems. Route completed intake cases to the review team and, once trained, assume responsibility for technical review of prior authorization cases.
Review prior authorization cases to determine medication coverage, including approval, denial, or partial coverage decisions.
Carefully read and interpret coverage criteria, standard operating procedures (SOPs), insurance documents, and medical documents to assess eligibility.
Make clinical determinations on whether medications are approved or denied based on established guidelines and managed care policies.
Perform accurate and timely data entry related to claims, prior authorizations, and patient information.
Provide professional customer service over the phone, handling calls from patients and providers regarding prior authorization status and requirements.
Control and guide conversations on calls, redirecting as needed to maintain focus and provide clear, concise information.
Work independently in a remote environment, maintaining productivity and adherence to performance and quality standards.
Ensure all work complies with HIPAA and other privacy and security requirements while working in a closed-door, distraction-limited setting.
Collaborate with team members to support rotating holiday coverage and flexible scheduling needs.
Participate in training and apply new processes, criteria, and system updates to daily work.
Essential SkillsActive pharmacy technician certification (such as CPhT).Hands-on experience as a pharmacy technician, preferably in a managed care or prior authorization setting.
Experience with managed care and pharmacy operations, including working with Medicare and Medicaid populations.
Demonstrated prior authorization experience, including intake, review, or claims-related activities.
Strong data entry skills with high accuracy and attention to detail.
Proficiency with computer systems and applications required for remote work and prior authorization processing.
Customer service experience over the phone, including handling inbound and outbound calls.
Ability to control conversations, manage difficult calls, and redirect discussions to maintain professionalism and clarity.
Capability to work remotely and independently while meeting performance expectations.
Solid understanding of pharmacy terminology and basic clinical concepts related to medication coverage and eligibility.
Job Type & LocationThis is a Contract to Hire position based out of Detroit, MI.Pay and BenefitsThe pay range for this position is $20.00 - $23.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment.
Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)
Experience: 2 years required