Prior Authorization Technician

Job Title: Prior Authorization Technician Industry: Healthcare Location: Remote (US) — shift hours are set in EST regardless of the candidate's actual time zone Shift: One of three schedules: 8:30 a.m.–5:00 p.m. EST, 9:00 a.m.–5:30 p.m. EST, or 9:30 a.m.–6:00 p.m. EST. Must be available to work weekends and holidays. Assignment length: 3 months. Client Overview You'd be working for a pharmacy benefit management team, processing prior authorization requests for medications from doctors, pharmacies, and patients, including requests for high cost specialty medications. Top 3 Skills Prior authorization processing and clinical criteria interpretationPharmacy and medical claims systemsOutbound and inbound call handling What You'll Do Interpret and apply clinical criteria during the prior authorization review processUse member claims history during the review processMake outbound calls to gather additional information needed to process requestsSubmit authorizations to pharmacy and medical claims processorsForward requests to a pharmacist when necessaryMake appropriate referrals to other clinical programsDirect requests to in network providers as appropriateReceive inbound calls from the customer care center with prior authorization inquiriesAssist with appeals processing as assignedAttend required training on an annual basis What We Need From You High school diploma or GED1 to 3 years of relevant experienceCertified Pharmacy Technician through PTCB or NHAMinimum 35 words per minute typing speedAvailable to work weekends and holidays, and shifts outside standard business hours Preferred / Bonus Previous PBM, managed care, hospital pharmacy, LTC pharmacy, home infusion, or retail pharmacy experience About Elevait Elevait Solutions was founded by veterans who believe that how you treat people is the only thing that actually matters in this industry. We're a team that stays in your corner before, during, and after placement. We show up for the communities we work in, we tell you the truth, and we work hard to make sure every placement is a good fit for both sides. If that sounds like the kind of team you want behind you, we'd like to talk. Elevait is a certified Service Disabled Veteran Owned Small Business, has over 100,000 LinkedIn followers, and was named a top company for hiring veterans by U.S. Veterans Magazine. We'd encourage you to check us out directly on our website and LinkedIn rather than just taking a recruiter's word for it. Buzzwords pharmacy, prior, authorization, clinical, criteria, claims, PBM, pharmaceutical, processing, review Top 3 LinkedIn Job Titles Prior Authorization TechnicianPharmacy TechnicianPBM Technician Internal Market Recap (Client: AmeriHealth, Remote/EST hours) Pay Positioning This req's candidate facing pay is capped at $29.08/hr. Market data for remote PBM prior authorization pharmacy technician roles typically runs $16 to $30/hr, with many comparable listings clustering around $16.55 to $20/hr, and one industry guide citing $26/hr as a strong example rate. This req's $29.08/hr ceiling is at or above most comparable postings, a competitive rate for this specific role type. Competitive Landscape Molina Healthcare, CVS Health (Caremark), Express Scripts, OptumRx, Prime Therapeutics, Magellan Rx Management, Elixir, MedImpact. Contractor to FTE Trends This req runs a short 3 month window with no stated conversion path. Frame it to candidates as a defined term assignment. Selling Points and Watch Outs Fully remote with no physical commute, a strong draw for pharmacy technicians who want to work from homePay rate sits at or above most comparable remote PBM prior authorization postings currently in the marketCandidates must be available to work weekends and holidays, and shifts don't fall on standard 9-5 hours, so make sure to confirm flexibility up frontAll shift options run on EST hours regardless of the candidate's actual location, so candidates in other time zones need to be comfortable adjusting their schedule accordinglyThis is a short, 3 month assignment with no stated conversion path, worth setting expectations early for candidates hoping for something longer term Candidate Profile A certified pharmacy technician (PTCB or NHA) with 1 to 3 years of experience, comfortable interpreting clinical criteria and handling a high volume of inbound and outbound calls. Likely coming from a PBM, managed care, hospital, or retail pharmacy background. Sourcing Channels Target current prior authorization and PBM pharmacy technicians at the competitor pharmacy benefit managers listed above, remote pharmacy technician job boards, and PTCB/NHA certified technician networks. LinkedIn Location Coverage Not applicable. This role is fully remote with no fixed work location, so there is no commute radius to build a coverage table around. Boolean Search String ("prior authorization" OR "pharmacy technician" OR PBM) AND ("clinical criteria" OR "claims history" OR "prior authorization" OR pharmacy) AND (PTCB OR NHA OR CPhT OR appeals OR specialty)