Clinical Pharmacy Technician Sr - Medi-Cal Rx

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

About the role

The Senior Clinical Pharmacy Technician – Medi-Cal independently manages prior authorization requests, eligibility, pharmacy benefits, and claims using established clinical criteria. This role serves as a technical resource to team members, supports resolution of non-routine cases, and identifies opportunities to improve workflow efficiency.

Responsibilities

• Independently review, research, and resolve prior authorization requests by applying clinical criteria, established guidelines, and professional judgment within defined protocols
• Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring clarity and accuracy in non-routine scenarios
• Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations, resolving moderately complex issues and determining appropriate next steps
• Escalate clinically complex or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support timely resolution
• Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks
• Initiate, prioritize, and manage cases by accurately gathering and entering member and provider information
• Identify trends, root causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, quality, and consistency
• Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities
• Other duties as assigned

Requirements

• High school diploma from an accredited school or equivalent GED
• 2 years of work experience as a pharmacy technician
• Licensed Pharmacy Technician in accordance with California state requirements
• Must be eligible to work in the United States without the need for work visa or residency sponsorship

Qualifications

• Strong knowledge of pharmacy workflows, terminology, and reimbursement processes
• Ability to prioritize work and manage multiple assignments in a dynamic environment
• Effective communication skills with the ability to guide and support team members
• Proficiency in pharmacy systems and Microsoft Office applications

Preferred Qualifications

• 1 year reimbursement experience
• PBM or health care experience

Benefits

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.