Prior Authorization Systems Technician (Pharmacy)

TL;DR

Prior Authorization Systems Technician (Pharmacy): Maintaining, configuring, and validating prior authorization criteria and clinical decision trees within an enterprise health platform with an accent on translating clinical requirements into system logic. Focus on performing structured QA, resolving configuration discrepancies, and ensuring regulatory compliance for pharmacy benefit management workflows.

Location: Must be based in the US (Remote or Hybrid in New York, NY, Charlotte, NC, or Denver, CO).

Salary: $78,400–$90,000 USD.

Company

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

What you will do

• Configure and maintain prior authorization criteria, rules, and source documentation within the platform.
• Operationalize weekly formulary and utilization management updates, including criteria changes and product additions.
• Perform structured validation and quality assurance of criteria builds, letter templates, and system configurations.
• Partner with clinical and formulary operations teams to resolve discrepancies in criteria logic and documentation.
• Support new drug-to-market implementations and maintain automated communication templates.
• Execute batch load testing, regression testing, and release validation for system updates.

Requirements

• 4+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy environment.
• National Certified Pharmacy Technician (CPhT) certification required.
• Demonstrated experience working with prior authorization systems, UM criteria, or clinical rule configuration.
• Strong understanding of prior authorization workflows, clinical guidelines, and formulary management.
• Proficiency in Microsoft Excel and Word for data analysis and validation.
• Must be authorized to work in the United States.

Nice to have

• Experience supporting system testing (UAT, regression, or configuration validation).
• Experience documenting clinical rationale or supporting materials for utilization management.
• Bachelor’s degree or equivalent combination of education and experience.
• Experience working cross-functionally with clinical, operational, and IT teams.

Culture & Benefits

• Comprehensive medical, pharmacy, dental, and vision insurance coverage.
• 401(k) plan with company match after one year of full-time employment.
• Company-paid basic life insurance, short-term and long-term disability.
• Paid time off, sick time, and holidays.
• Access to flexible spending accounts and health savings accounts.
• Employee assistance program and wellness program.