Senior Pharmacy Technician, Utilization Management

Responsibilities

• Receive, process, and conduct non-clinical review of pharmacy prior authorization requests
• Verify member eligibility, benefit coverage, and authorization requirements
• Escalate clinical or coverage determinations to a pharmacist per established workflows
• Lead workload distribution, queue prioritization, and turnaround-time monitoring for UM technicians
• Conduct quality reviews and provide coaching, training, and onboarding support
• Develop and maintain technician workflows, SOPs, and job aids
• Serve as super-user for the prior authorization technology platform and lead configuration and UAT
• Support audits, appeals, accreditation readiness, and process-improvement initiatives

Requirements

• Bachelor's degree in healthcare administration, business, pharmacy, health sciences, or related field
• 5+ years pharmacy technician experience, including 3+ years in UM, managed care, or PBM
• Active pharmacy technician registration and current CPhT credential
• Experience training, mentoring, or coordinating others
• Working knowledge of prior authorization, pharmacy benefits, and formulary management
• Familiarity with NCQA, URAC, ERISA, and state UM requirements
• Strong analytical, communication, and problem-solving skills
• Ability to maintain confidentiality and handle PHI
• Willingness to travel 10-20%

Preferred Qualifications

• Prior experience as a senior technician, trainer, quality reviewer, or workflow coordinator
• Experience supporting UM technology platform implementation or validation

Benefits

• Competitive compensation with health, dental, and vision coverage

About the Company

AffirmedRx is a pharmacy benefit management company focused on clarity, integrity, and trust in health care outcomes.