Senior Pharmacy Technician, Utilization Management

AffirmedRx, a Public Benefit Corporation

. Receive, process, and conduct non-clinical review of pharmacy prior authorization requests and supporting documentation .

Posted 11/9/2026full-timeRemote • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in pharmacy prior authorization processes, including eligibility verification, documentation management, and operational configuration. Proficient in training and mentoring teams while ensuring compliance with regulatory standards and improving workflow efficiencies.

Highest-signal resume keywords

Pharmacy Technician ExperienceUtilization Management PlatformsCertified Pharmacy Technician (CPhT)Operational ConfigurationRegulatory Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Pharmacy Prior Authorization OperationsFormulary ManagementException ProcessingQuality ReviewProcess Improvement InitiativesUser Acceptance TestingDocumentation ManagementAnalytical SkillsAttention to DetailCustomer Service

Soft Skills

Organizational SkillsWritten CommunicationVerbal CommunicationProblem-Solving SkillsTeam Collaboration

Tools & Technologies

Microsoft Office ApplicationsPharmacy Claims SystemsUtilization Management Technology

Certifications & Qualifications

Active Pharmacy Technician RegistrationCertified Pharmacy Technician (CPhT)

Industry Keywords

Healthcare AdministrationManaged CarePharmacy Benefit OperationsNCQAURACERISAUtilization ManagementPharmacy Benefits

About the role

Key responsibilities & impact

Receive, process, and conduct non-clinical review of pharmacy prior authorization requests and supporting documentation
Verify member eligibility, benefit coverage, authorization requirements, and administrative information
Enter, update, and maintain authorization records in UM, pharmacy claims, and related systems
Obtain and document required information from providers, pharmacies, members, and other healthcare entities
Assess submission completeness, route requests to the appropriate review level, and escalate non-standard cases to pharmacists
Prepare cases for pharmacist review and communicate authorization status or additional-information requests
Maintain complete documentation of case activities, communications, and outcomes
Monitor work queues and prioritize requests to meet turnaround-time and notification requirements
Support appeals, reconsiderations, audits, quality initiatives, and regulatory or accreditation activities
Serve as a subject matter expert for UM technicians on workflows, policies, procedures, benefits administration, and system functionality
Manage workload distribution, queue prioritization, and urgent requests across the UM technician team
Monitor operational performance indicators, analyze barriers, implement corrective actions, and report outcomes to UM leadership
Conduct quality reviews and provide coaching, feedback, training, onboarding, and mentoring
Develop and maintain technician workflows, standard operating procedures, job aids, and training materials
Investigate and resolve non-clinical authorization issues, workflow conflicts, and provider or pharmacy inquiries
Serve as super-user for prior authorization technology and related UM systems
Lead configuration, testing, validation, implementation, maintenance, formulary updates, UM programs, system enhancements, and client-specific workflows
Collaborate with pharmacists, UM leadership, operations, clinical configuration, claims, and technology teams
Identify and implement process improvements and support audit preparation, accreditation readiness, corrective actions, and compliance initiatives

Requirements

What you’ll need

Bachelor’s degree in Healthcare Administration, Business Administration, Pharmacy, Health Sciences, or a related field
5+ years of pharmacy technician experience, including at least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations
Active pharmacy technician registration, licensure, or other credential required by the state(s) in which the employee performs services
Current Certified Pharmacy Technician (CPhT) credential
Prior experience in a senior technician, trainer, quality reviewer, or workflow coordinator capacity
Experience supporting operational configuration, user acceptance testing, validation, implementation, or maintenance of prior authorization or UM technology platforms
Experience supporting pharmacy benefit configuration, formulary changes, clinical program implementation, audits, or process-improvement initiatives
Familiarity with NCQA, URAC, ERISA, state-specific, or other applicable utilization management and pharmacy benefit requirements
Demonstrated experience training, mentoring, coaching, or coordinating the work of others
Working knowledge of pharmacy prior authorization operations, pharmacy benefits, formulary management, exception processing, and appeals support
Experience using utilization management platforms, pharmacy claims systems, and Microsoft Office applications
Strong analytical, organizational, written and verbal communication, customer service, and problem-solving skills
Ability to exercise judgment and discretion in ambiguous or non-standard operational situations and escalate matters requiring pharmacist review
Demonstrated ability to exercise discretion and independent judgment in resolving operational matters of significance without prior approval
Ability to manage multiple priorities, meet turnaround-time expectations, and maintain accuracy and attention to detail in a fast-paced environment
Ability to work independently and collaboratively across clinical, operational, and technical teams
Ability to maintain confidentiality and appropriately handle protected health information (PHI)
Dedicated, private, and secure remote work environment meeting organizational requirements
Willingness to travel 10–20%

Benefits

Comp & perks

Competitive compensation, including health, dental, vision and other benefits
Opportunity to impact industry change in the pharmacy benefits management space while delivering high-quality patient outcomes
Culture where people thrive
Remote work arrangement