Job at a glance
Actalent is Hiring a Team of Remote Pharmacy Technicians Job Description This remote Pharmacy Technician role focuses on reviewing prior authorization requests and making coverage determinations for a pharmacy services department within a large health insurance organization. You will evaluate requests for a wide range of medications and health plans, document decisions in the pharmacy benefit management (PBM) system, and collaborate closely with pharmacists for final review.
This position offers limited phone work, long-term career potential, and the opportunity to transition to a permanent role with benefits. Responsibilities Review prior authorization requests for prescription medications across multiple health plans and drug types. Apply established clinical and coverage criteria to determine whether to approve or deny prior authorization requests. Forward all coverage determinations to a pharmacist for final review and sign-off.
Track and manage coverage determination requests to ensure timely processing and resolution. Enter all decisions and supporting information accurately into the PBM system and other internal platforms. Obtain verbal authorizations from prescribers and other stakeholders as needed. Request and collect detailed clinical information from prescribers to support coverage determinations. Notify providers, members, and other stakeholders of decision outcomes in a clear and timely manner.
Respond to client inquiries related to prescription benefits, prior authorizations, and coverage decisions. Refer requests involving specialty medications or complex cases to the appropriate specialty pharmacy or internal team. Contact providers for additional information or clarification when documentation is incomplete or unclear. Assist with inbound and outbound patient or physician calls when needed, with an emphasis on outbound communication.
Handle prescription benefit-related questions and issues in a professional, customer-focused manner. Use multiple computer systems and screens simultaneously to research cases, document actions, and update records. Maintain accurate, detailed records of all interactions, decisions, and supporting documentation. Meet productivity, quality, and accuracy metrics while adhering to all applicable policies and procedures.
Participate fully in remote training sessions, apply learned processes, and adapt to updates in workflows or criteria. Protect confidential member and provider information and follow all applicable privacy and security guidelines. Additional Skills & Qualifications National pharmacy technician certifications such as PTCB or NHA. Experience working with Medicare and Medicaid prescription benefits.
Background in retail pharmacy, hospital pharmacy, specialty pharmacy, PBM, or call center environments. Experience handling prescription benefits and prior authorization workflows in an insurance or managed care setting. Strong written and verbal communication skills for documenting decisions and communicating with providers and members. Comfort working with multiple systems and adapting to new technologies and software platforms.
Ability to meet performance metrics and quality standards in a high-volume, process-driven environment. Interest in long-term career growth within a large, nationwide healthcare organization. Motivation to transition from contract to permanent employment, including eligibility for benefits and paid time off. Work Environment This is a fully remote position based in a professional home office environment, aligned with Eastern Standard Time for training and operations.
Training runs from 10:00 a.m. to 6:30 p.m. EST, after which you will move to your regular shift. You must be available Monday through Friday between 8:00 a.m. and 8:00 p.m. in your local time zone and participate in a rotating weekend schedule approximately every 4–6 weeks, as well as some holidays. Holiday schedules are assigned through a bidding process. Schedules are provided approx