{"id":3997633,"url":"https://alion.io/job/affirmedrx-senior-pharmacy-technician-utilization-management","title":"Senior Pharmacy Technician, Utilization Management","company":{"id":6629,"name":"AffirmedRx","domain":"affirmedrx.com","url":"https://alion.io/company/affirmedrx","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Greenhouse","truth_index":null},"role":"Field & Service","role_family":"Field & Service","seniority":"senior","employment_type":null,"work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":[],"countries":[],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"HIPAA","optional":false},{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-11-09T23:04:40Z","employer_posted_date":"2026-11-10","last_verified_at":"2026-11-12T17:34:46Z","board_verified":true,"closed_at":null,"days_open":2,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":2},"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.\nJoin us in improving health care outcomes for all! We promise to do what’s right, always.\nPosition Summary:\nThe 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.\nWhat you will do:\nUtilization Management Operations: \nReceive, process, and conduct non-clinical review of pharmacy prior authorization requests and supporting documentation\nVerify member eligibility, benefit coverage, authorization requirements, and applicable administrative information\nEnter, update, and maintain authorization records within UM, pharmacy claims, and related systems\nObtain and document required information from providers, pharmacies, members, and other health care entities\nAssess 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\nPrepare cases for pharmacist review and escalate requests requiring clinical judgment or a coverage determination in accordance with established workflows\nCommunicate authorization status, requests for additional information, and other non-clinical case information to providers, pharmacies, and members, as appropriate\nMaintain accurate and complete documentation of case activities, communications, and outcomes\nMonitor assigned work queues and prioritize requests to support compliance with applicable turnaround-time and notification requirements\nSupport appeals, reconsiderations, audits, quality initiatives, and regulatory or accreditation activities within the technician scope of responsibility\nProtect confidential information and comply with HIPAA and all applicable federal, state, client, contractual, and organizational requirements\nOperational Support and Coordination:\nServe as a subject matter expert for UM technicians regarding workflows, policies, procedures, benefit administration, and system functionality\nDetermine and manage workload distribution, queue prioritization, and coordination of urgent or time-sensitive requests across the UM technician team\nMonitor 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\nConduct quality reviews, identify recurring errors or workflow gaps, and provide coaching, feedback, and training to support accuracy, consistency, and compliance\nSupport onboarding, mentoring, and ongoing development of new and existing UM technicians\nDevelop, maintain and operationalize technician workflows, standard operating procedures, job aids, and training materials.\nInvestigate and resolve non-clinical authorization issues, workflow conflicts, and provider or pharmacy inquiries, exercising discretion to determine the appropriate resolution\nServe 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\nProvide backup support for designated operational leadership functions, as assigned\nTechnology, Implementation, and Process Improvement: \nServe as a super-user for the prior authorization technology platform and related UM systems\nLead operational configuration, user acceptance testing, validation, implementation, and ongoing maintenance of prior authorization technology platforms\nLead implementation of formulary updates, utilization management programs, system enhancements, and client-specific workflows\nCollaborate with pharmacists, UM leadership, operations, clinical configuration, claims, and technology teams to investigate and resolve workflow or system issues\nIdentify opportunities to improve efficiency, accuracy, service, and the user experience; assist with development and implementation of sustainable process improvements\nSupport audit preparation, accreditation readiness, corrective-action activities, and compliance initiatives\nWhat you need:\nBachelor’s degree in Healthcare Administration, Business Administration, Pharmacy, Health Sciences, or a related field\n5+ years of pharmacy technician experience, including at least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations\nActive pharmacy technician registration, licensure, or other credential required by the state(s) in which the employee performs services\nCurrent Certified Pharmacy Technician (CPhT) credential\nPrior experience in a senior technician, trainer, quality reviewer, or workflow coordinator capacity\nExperience supporting operational configuration, user acceptance testing, validation, implementation, or maintenance of prior authorization or UM technology platforms\nExperience supporting pharmacy benefit configuration, formulary changes, clinical program implementation, audits, or process-improvement initiatives\nFamiliarity with NCQA, URAC, ERISA, state-specific, or other applicable utilization management and pharmacy benefit requirements\nDemonstrated experience training, mentoring, coaching, or coordinating the work of others\nWorking knowledge of pharmacy prior authorization operations, pharmacy benefits, formulary management, exception processing, and appeals support\nExperience using utilization management platforms, pharmacy claims systems, and Microsoft Office applications\nStrong analytical, organizational, written and verbal communication, customer service, and problem-solving skills\nAbility to exercise judgment and discretion to resolve ambiguous or non-standard operational situations, and to recognize and escalate matters that require pharmacist review\nDemonstrated ability to exercise discretion and independent judgment in resolving operational matters of significance without prior approval\nAbility to manage multiple priorities, meet turnaround-time expectations, and maintain accuracy and attention to detail in a fast-paced environment\nAbility to work independently and collaboratively across clinical, operational, and technical teams\nAbility to maintain confidentiality and appropriately handle protected health information (PHI)\nDedicated, private, and secure remote work environment that meets organizational requirements\nWillingness to travel 10-20%\nWhat you get:\nTo impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes\nTo work in a culture where people thrive because when OUR team thrives, OUR business thrives\nCompetitive compensation, including health, dental, vision and other benefits\nNote: \nAffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. 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