Clinical Pharmacy Technician Sr - Medi-Cal Rx (Remote California)

Prime Therapeutics•Home, WV

1d•$19 - $29•Remote

About The Position

The Senior Clinical Pharmacy Technician – Medi-Cal independently manages prior authorization requests, eligibility, pharmacy benefits, and claims using established clinical criteria. This role serves as a technical resource to team members, supports resolution of non-routine cases, and identifies opportunities to improve workflow efficiency.

Requirements

High school diploma from an accredited school or equivalent GED
2 years of work experience as a pharmacy technician
Licensed Pharmacy Technician in accordance with California state requirements
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Strong knowledge of pharmacy workflows, terminology, and reimbursement processes
Ability to prioritize work and manage multiple assignments in a dynamic environment
Effective communication skills with the ability to guide and support team members
Proficiency in pharmacy systems and Microsoft Office applications

Nice To Haves

1 year reimbursement experience
PBM or health care experience

Responsibilities

Independently review, research, and resolve prior authorization requests by applying clinical criteria, established guidelines, and professional judgment within defined protocols
Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring clarity and accuracy in non-routine scenarios
Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations, resolving moderately complex issues and determining appropriate next steps
Escalate clinically complex or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support timely resolution
Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks
Initiates, prioritize, and manage cases by accurately gathering and entering member and provider information
Identify trends, root causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, quality, and consistency
Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities
Other duties as assigned