Prior Authorization Pharmacy Technician (Seasonal)

The Prior Authorization Pharmacy Technician will assist members, providers, and pharmacies in navigating prescription complexities to ensure timely coverage of medications. This includes verifying eligibility and drug coverage, triaging clinical review processes for prior authorization requests according to established protocols, and reviewing these requests using prior authorization criteria, claims history, and plan benefit rules. Responsibilities also involve prescriber/pharmacy outreach to gather complete information, organizing and prioritizing requests for timely case management, building and adjusting authorizations within the claim adjudication system, and using pharmacy technician experience for basic calculations and claims adjudication monitoring. The role requires critically assessing member clinical situations against medication policies, making determinations for approval or triaging to a Pharmacist, and evaluating when medications need further review based on synthesized protocols. Additionally, the technician will reach out to external stakeholders for approval on drugs with dollar limits and coordinate outreach across teams to address questions and guide processes.