Pharmacy Technician

Pharmacy Technician – Remote (Tri‑State Region: PA, DE, NJ) Schedule: Monday–Friday, Day Shift Work Model: Remote (Candidate must reside in PA, DE, or NJ)

About the Role We are seeking a detail‑oriented and clinically knowledgeable Pharmacy Technician to support medical necessity review and authorization processes. In this role, you will review patient medical records, evaluate clinical information, and make independent determinations using established medical criteria. You will collaborate with providers, ensure regulatory compliance, and maintain high standards for accuracy and documentation. This position requires strong critical‑thinking skills, familiarity with medical policies, and the ability to work independently in a fast‑paced environment.

Key Responsibilities Clinical Review & Case Evaluation

Review medical records—including medical history, treatment plans, and progress notes—to assess medical necessity of requested services. Apply advanced clinical knowledge, judgment, and approved criteria to make case determinations. Utilize resources such as Care Management Policy, Medical Policy, MicroMedex, and electronic reference tools to support decisions.

Provider Communication & Care Coordination

Contact servicing providers to clarify treatment plans, confirm clinical need, or request additional information. Notify ordering providers and Specialty Pharmacy vendors once authorizations are approved to ensure timely medication shipment. Review treatment plans with providers and confirm all required information for processing.

Authorization & Regulatory Compliance

Independently authorize medically necessary services within the scope of policy. Refer cases that fall outside established criteria to a Clinical Care Coordinator for further evaluation. Validate that requested services are covered under the member’s benefit plan. Ensure all utilization decisions adhere to federal, state, and accreditation regulations.

Documentation & Data Integrity

Maintain complete, accurate documentation in accordance with Care Management and Coordination Policy. Perform timely and precise data entry to ensure system accuracy. Meet or exceed regulatory turnaround times and departmental productivity goals.

Required Qualifications

Pharmacy Technician experience in a clinical, utilization management, or medical review environment strongly preferred. Strong knowledge of medical terminology, pharmacy workflows, and clinical documentation. Ability to apply medical necessity criteria and interpret clinical records. Excellent communication and critical‑thinking skills. Must reside in Pennsylvania (PA), Delaware (DE), or New Jersey (NJ).

Preferred Skills & Attributes

Experience working with medical policies, care management references, or clinical guidelines. Strong interpersonal skills and comfort interacting with healthcare providers. High attention to detail and commitment to accuracy. Ability to manage multiple priorities and meet tight deadlines in a structured environment. Familiarity with healthcare regulatory requirements.

Work Environment

Fully remote role supporting clinical and administrative processes. Requires independent decision‑making and consistent communication with internal teams and providers. Task‑driven position with clear workflow expectations and defined escalation paths.