Pharmacy Technician

This role focuses on processing and managing pharmacy coverage determination and prior authorization requests in a remote environment. The Pharmacy Prior Authorization Specialist reviews requests from providers, gathers necessary clinical information, applies defined criteria to approve requests when appropriate, and documents decisions in the pharmacy benefit management (PBM) system. The position requires strong attention to detail, excellent communication skills, and the ability to work effectively with prescribers, providers, members, and internal teams.

Responsibilities

• Track and triage coverage determination requests submitted by providers and determine when a pharmacist review is required.
• Obtain verbal authorizations and request detailed clinical information from prescribers to support coverage determinations.
• Review and approve coverage determination requests based on defined clinical and plan criteria.
• Enter and document coverage determination decisions accurately in the PBM system.
• Notify providers and members of coverage determination decisions in a clear and timely manner.
• Respond to client inquiries regarding authorization approvals and PBM online applications.
• Refer coverage determination requests for specialty drugs to the appropriate delegated vendor or client for processing.
• Contact providers for additional information when needed to complete coverage determination reviews.
• Communicate coverage determination outcomes to physicians, providers, and members, ensuring they understand the decision and next steps.
• Maintain a high level of accuracy and productivity while handling a large volume of prior authorization and coverage determination requests.
• Collaborate with team members and leadership to support process improvements and ensure compliance with managed care and Medicare/Medicaid requirements.

• Current or recent experience in a pharmacy or pharmacy-related environment.
• Pharmacy technician license, with the ability to apply pharmacy knowledge to prior authorization processes.
• Hands-on experience with prior authorizations and coverage determination workflows.
• Strong data entry skills with high accuracy and attention to detail.
• Customer service experience, with the ability to communicate professionally with providers, prescribers, and members.
• Proficiency with Microsoft applications, including the ability to navigate and document information in multiple systems.
• Experience working within managed care settings, including familiarity with health plan and PBM operations.
• Knowledge of Medicare and Medicaid pharmacy benefits and authorization requirements.
• Ability to work effectively in a remote environment, using computer-based tools and communication platforms.

• Prior experience handling pharmacy benefit prior authorizations in a PBM or managed care organization.
• Comfort working with PBM online applications and authorization systems.
• Strong organizational skills to manage multiple coverage determination requests simultaneously.
• Effective verbal communication skills for obtaining clinical information and providing clear explanations of decisions.
• Ability to work both independently and collaboratively in a remote team setting.
• Adaptability to changing processes, criteria, and system updates related to managed care and government programs.

This position operates in a 100% remote work environment and requires a reliable home office setup with appropriate computer and internet access. Standard start times range from as early as 8:00 a.m. EST to no later than 10:00 a.m. EST, with a one-hour lunch break during the regular schedule. The training schedule runs from 10:00 a.m. to 6:30 p.m. EST, Monday through Friday, with a 30-minute unpaid lunch. After training, the role includes rotating weekend coverage every 4 to 6 weeks. Work is computer-based, involving extensive use of PBM systems, Microsoft applications, and online communication tools, and requires sustained focus, accuracy, and professionalism in all interactions.

Job Type & Location

This is a Contract to Hire position based out of Lexington, KY.

The pay range for this position is $18.00 - $22.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on May 20, 2026.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I is embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

Actalent is an equal opportunity employer.

About Actalent

Actalent is a global leader in engineering and sciences services. For more than 40 years, we’ve helped visionary companies advance their goals. Headquartered in the United States, our teams span 150 offices across North America, EMEA, and APAC—with four delivery centers in India led by 1,000+ extraordinary employees who connect their passion with purpose every day.

Our Bangalore, Hyderabad, Pune, and Chennai delivery centers are hubs of engineering expertise, with core capabilities in mechanical and electrical engineering, systems and software, and manufacturing engineering. Our teams deliver work across multiple industries including transportation, consumer and industrial products, and life sciences. We serve more than 4,500 clients, including many Fortune 500 brands. Learn more about how we can work together at actalentservices.com.