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AffirmedRx, PBC

Senior Pharmacy Technician, Utilization Management

Remote, United States

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Job details

Experience: 5+ years of pharmacy technician experience, including at least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations
Posting language: English
Posted: Nov 9, 2026

Original job description

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology.

Join us in improving health care outcomes for all! We promise to do what’s right, always.

Position Summary:

The Senior Pharmacy Technician, Utilization Management leads the non-clinical administration of pharmacy utilization management (UM) programs by receiving, processing, and conducting non-clinical review of prior authorization requests, in accordance with established workflows, coverage criteria, and regulatory requirements, and escalating non-standard or ambiguous situations to a pharmacist. The role obtains required clinical and administrative information and serves as a liaison among providers, pharmacies, members, and internal departments to support accurate, efficient, and timely authorization processes. This position does not make clinical coverage determinations requiring pharmacist licensure; however, the role exercises discretion and independent judgment on non-clinical operational, workflow, and quality matters within UM, such as work prioritization, process gaps, and workflow improvements. In addition to performing pharmacy technician responsibilities, the Senior Pharmacy Technician serves as a subject matter expert and owner of day-to-day UM operations for the UM team. The role leads workflow coordination, training and quality oversight, and the resolution of non-clinical escalations, and serves as a super-user for UM technology.

What you will do:

Utilization Management Operations:

Receive, process, and conduct non-clinical review of pharmacy prior authorization requests and supporting documentation
Verify member eligibility, benefit coverage, authorization requirements, and applicable administrative information
Enter, update, and maintain authorization records within UM, pharmacy claims, and related systems
Obtain and document required information from providers, pharmacies, members, and other health care entities
Assess incoming prior authorization submissions for completeness and route them to the appropriate level of review, escalating to a pharmacist when standard criteria, business rules, or established workflows do not clearly apply
Prepare cases for pharmacist review and escalate requests requiring clinical judgment or a coverage determination in accordance with established workflows
Communicate authorization status, requests for additional information, and other non-clinical case information to providers, pharmacies, and members, as appropriate
Maintain accurate and complete documentation of case activities, communications, and outcomes
Monitor assigned work queues and prioritize requests to support compliance with applicable turnaround-time and notification requirements
Support appeals, reconsiderations, audits, quality initiatives, and regulatory or accreditation activities within the technician scope of responsibility
Protect confidential information and comply with HIPAA and all applicable federal, state, client, contractual, and organizational requirements

Operational Support and Coordination:

Serve as a subject matter expert for UM technicians regarding workflows, policies, procedures, benefit administration, and system functionality
Determine and manage workload distribution, queue prioritization, and coordination of urgent or time-sensitive requests across the UM technician team
Monitor workload, turnaround times, productivity, quality, and other operational performance indicators; analyze trends or barriers and determine and implement corrective action, reporting outcomes to UM leadership
Conduct quality reviews, identify recurring errors or workflow gaps, and provide coaching, feedback, and training to support accuracy, consistency, and compliance
Support onboarding, mentoring, and ongoing development of new and existing UM technicians
Develop, maintain and operationalize technician workflows, standard operating procedures, job aids, and training materials.
Investigate and resolve non-clinical authorization issues, workflow conflicts, and provider or pharmacy inquiries, exercising discretion to determine the appropriate resolution
Serve as a day-to-day resource for UM technicians by providing guidance on established workflows, priorities, and non-clinical operational questions; resolve non-clinical matters and escalate clinical or coverage questions to a pharmacist and operational concerns to UM leadership
Provide backup support for designated operational leadership functions, as assigned

Technology, Implementation, and Process Improvement:

Serve as a super-user for the prior authorization technology platform and related UM systems
Lead operational configuration, user acceptance testing, validation, implementation, and ongoing maintenance of prior authorization technology platforms
Lead implementation of formulary updates, utilization management programs, system enhancements, and client-specific workflows
Collaborate with pharmacists, UM leadership, operations, clinical configuration, claims, and technology teams to investigate and resolve workflow or system issues
Identify opportunities to improve efficiency, accuracy, service, and the user experience; assist with development and implementation of sustainable process improvements
Support audit preparation, accreditation readiness, corrective-action activities, and compliance initiatives

What you 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 to resolve ambiguous or non-standard operational situations, and to recognize and escalate matters that require 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 that meets organizational requirements
Willingness to travel 10-20%

What you get:

To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes
To work in a culture where people thrive because when OUR team thrives, OUR business thrives
Competitive compensation, including health, dental, vision and other benefits

Note:

AffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.

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