Prior Authorization Pharmacy Technician (Seasonal)

The Prior Authorization Pharmacy Technician will assist members, providers, pharmacies, and internal teams 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, and reviewing requests under established protocols using prior authorization criteria, claims history, and plan benefit rules. Responsibilities also involve coordinating outreach to prescribers and pharmacies, organizing and prioritizing requests for timely case management, building and adjusting authorizations within the claim adjudication system, and using pharmacy technician experience to navigate drug products and perform basic calculations for claims adjudication. The role requires critically assessing member clinical situations against medication policies, making determinations for approval or triage to a Pharmacist, and evaluating when medications need further internal or external review. Additionally, the technician will reach out to external stakeholders for approval on drugs with dollar limits and work across teams to coordinate outreach, address questions, and guide processes for appropriate medication coverage.