FairosRx Clinical Associate (On-Site or Remote) - Pharmacy Technician Certification Required

About the Role

As a Clinical Associate, you will support pharmacy benefit operations by coordinating clinical and administrative workflows, reviewing documentation, and communicating with members, providers, pharmacy staff, clients, and internal stakeholders. The role helps ensure accurate, timely, and compliant processing of pharmacy benefit requests while supporting service quality and operational efficiency.

What It's Like to Work Here

At OccuNet, you matter like we matter! Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate.

A Day in the Life

The FairosRx Clinical Associate will support the clinical team in prior authorization case reviews, complete administrative tasks related to prior authorizations and appeals; support and assist member services, members, healthcare providers, and internal stakeholders with claim resolution, coverage questions, formulary questions and pharmacy benefit determinations. Perform other assigned duties and assist with special projects.

Responsibilities

• Collect, verify, and document clinical information from providers, pharmacies, and members
• Assist pharmacists with utilization management, coverage determinations, and appeals processing
• Monitor work queues and meet productivity, quality, and turnaround time expectations
• Process pharmacy claims and resolve claim adjudication issues
• Research member eligibility, benefit coverage, and medication history
• Communicate with prescribers, pharmacies, and members regarding authorization status, coverage requirements, and alternative therapies
• Provide customer service and respond to inquiries related to pharmacy benefits and medication coverage
• Maintain accurate case documentation in pharmacy management systems
• Support formulary management initiatives, including step therapy and quantity limit programs
• Ensure compliance with HIPAA, client requirements, and regulatory standards
• Maintain confidentiality of protected health information
• Assist with other duties and special projects as assigned

Requirements

• Excellent communication and interpersonal skills, written and verbal, with the ability to adapt appropriately for different audiences
• Able to multi-task effectively and transition between tasks frequently and maintain focus when presented with interruptions
• Proficient computer skills, including Microsoft Office Suite
• Team-first mindset with a high level of motivation and drive
• High school diploma or equivalent
• Active certified pharmacy technician (CPhT)
• Prolonged periods sitting or standing at a desk and working on a computer
• Full-time, Monday to Friday 8 am – 5 pm CST

Preferred Qualifications

• PBM experience preferred
• A track record of fostering collaboration, resolving conflicts and managing projects preferred

Benefits

• 401(k) with matching
• Dental insurance
• Health insurance
• Vision insurance
• Health savings account
• Paid time off

Culture and Opportunities

• We pride ourselves on our outward mindset – supporting each other and putting the team and the clients we serve first
• High-growth environment with clear opportunities for career growth
• Welcoming atmosphere and culture