Clinical, Manager, Prior Authorization Technician

Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required. Bachelor’s or Associate’s degree preferred. 4+ years of PBM or Managed Care pharmacy experience required. Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint. Strong clinical background required. Excellent communication, writing, and organizational skills. Ability to multi-task and collaborate in a team with shifting priorities. 2+ years of regulated market prior authorization operations experience or knowledge preferred.

Oversee a team of pharmacy technicians for prior authorization. Analyze data for staffing, workflow, and system enhancement recommendations. Participate in setting prior authorization technician metrics and quality goals. Generate reports on prior authorization technician metrics. Assist in hiring, evaluation, training, and onboarding of new employees. Investigate and resolve escalated issues. Ensure optimization of the prior authorization review platform. Maintain relationships with external Independent Review Organizations and clinical resource vendors. Support training and growth of staff. Collaborate with leadership on process improvements and business needs. Prepare prior authorization requests by validating information and clinical guidelines. Maintain compliance with laws and organizational standards. Obtain clinical information from prescribers and staff. Triage phone calls from members, pharmacy personnel, and providers. Follow Standard Operating Procedures and HIPAA guidelines.