Central Prior Authorization Pharmacy Technician

The Christ Hospital Health Network•Cincinnati, OH

About The Position

The Central Prior Authorization (PA) Pharmacy Technician II provides support to pharmacists and managers in all aspects of providing pharmacy services. Under the general supervision of the Assistant Director of Pharmacy, and according to standard procedure, the Central PA Pharmacy Technician II completes prior authorizations upon receiving orders from a licensed practitioner, and performs all duties necessary to support the effective daily operation of all departmental services and programs.

Requirements

High school diploma or GED required.
A minimum of 2 years of pharmacy technician experience required.
Must meet all minimum qualifications for a Central PA Pharmacy Technician I
A work history of qualitative consistency, productivity and appropriate independence.
A work history of initiative, motivation and flexibility.
A work history of above average quality, quantity and knowledge of work.
A work history of above average attendance and reliability.
Ohio State Board of Pharmacy Technician Registration Required
Certified Pharmacy Technician (PTCB/CPhT) certification required.
Must keep active PTCB/CPhT certification and registration with the Ohio State Board of Pharmacy for duration of employment as a Pharmacy Technician.

Nice To Haves

Retail pharmacy or ambulatory care experience preferred.

Responsibilities

Analyzes PA submissions from providers to ensure they meet clinical and formulary guidelines.
Reviews patient history, lab results, and diagnosis codes when available.
Assesses medical necessity based on criteria such as FDA-approved indications, compendia, and internal policies.
Uses evidence-based guidelines (e.g., Medicare Part D, NCCN, IDSA, ADA) to determine approval or denial.
Identifies off-label use and evaluates its appropriateness.
Requests additional documentation or clarification when needed.
Explains coverage decisions and educate on formulary alternatives or step therapy requirements.
Enters decisions into pharmacy benefit management (PBM) or health plan systems.
Ensures accurate record-keeping for compliance and audit purposes.
Works with case managers, medical directors, and utilization review teams.
Participates in interdisciplinary discussions about complex or high-cost cases.
Identifies potential overuse, misuse, or inappropriate prescribing patterns.
Flags questionable cases for further investigation.
Stays current on formularies, new drug approvals, clinical guidelines, and payer policies.
Attends continuing education and internal training sessions.
Prepares clinical rationales for appeal responses in conjunction with a pharmacist.
Reviews new evidence submitted during appeal reviews.
Educates prescribers, patients, and internal staff about prior authorization processes and criteria.
Helps reduce PA burden through proactive outreach and education on preferred alternatives.
Participates in audits and contributes to quality improvement initiatives.
Helps streamline workflows and improve efficiency in the PA process.
Performs Pharmacy Technician II duties and responsibilities in other areas across the network including but not limited to the retail, inpatient, and ambulatory pharmacy departments as needed.
As a representative of The Christ Hospital Health Network and Department of Pharmacy Services, promotes a positive image in all dealings with all other hospital associates and hospital customers.
Performs other duties as deemed necessary by the Director of Pharmacy, Assistant Director, and pharmacists.