Clinical Prior Authorization Technician (Temp to Hire)

TL;DR

Clinical Prior Authorization Technician (Temp to Hire): Prepare complex prior authorization requests by identifying clinical guidelines for review and ensuring substantial clinical information exists for pharmacist review with an accent on proactive outreach, problem-solving, and triaging internal calls. Focus on analyzing pharmacy claims data, creating decision trees from clinical guidelines, and supporting departmental projects.

Location: Remote (U.S. only)

Salary: $50,000 - $60,000 USD

Company

hirify.global is an enterprise health technology company providing pharmacy benefit management solutions and a proprietary Enterprise Health Platform for employers and health plans.

What you will do

• Prepare complex prior authorization requests by identifying clinical guidelines and ensuring sufficient clinical information for pharmacist review.
• Proactively obtain clinical information from prescribers and staff to address all clinical guidelines.
• Triage phone calls from members, pharmacy personnel, and providers using drug and client-specific questions.
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Support the department by creating decision trees from clinical guidelines and assisting with projects.
• Train call center technicians on protocols for prior authorization intake and follow standard operating procedures.

Requirements

• Minimum of 1 year experience as UM Technician I at Capital Rx
• State or National Certified Pharmacy Technician (CPhT) license required
• High school diploma or equivalent; Associate’s or Bachelor’s degree preferred
• Excellent communication, writing, and organizational skills
• Ability to multitask, collaborate in a team, and demonstrate project management skills
• Self-motivated, detail-oriented problem solver

Culture & Benefits

• Diverse workplace with equal employment opportunities
• Adherence to Code of Conduct and reporting of non-compliance
• Flexible position allowing reassignment of duties as needed