Care Guide Jobs (NOW HIRING)

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

Role and Responsibilities

• First level review of prior authorizations for GLP-1 therapies, ensuring accurate documentation.

• Meet standard prior authorization turnaround times, quality standards, and regulatory requirements.

• Follow up to ensure timely medication fills and renewals.

• Educate members on clinical programs that optimize prescription coverage, co-pay assistance, and other reimbursement options.

• Guide members through accessing lifestyle vendor programs, answering questions, and resolving concerns.

• Serve as a liaison between members and vendors to ensure smooth transitions.

• Maintain accurate records of member interactions and updates.

• Generate regular reports on member engagement and program participation for the clinical team.

• Understands the pharmacy benefit plans and accurately interprets the plan information.

• Communicate with clinical reviewers on issues related to formulary, non-formulary criteria, or respective policies and procedures.

• Ensure that all departmental goals (including, but not limited to turnaround times, production expectations, and quality metrics) are met.

• Actively participate in internal quality improvement process enhancements.

• Participate in clinical services team training and professional development opportunities.

• Assists with clinical program operations as required according to business needs

• Other duties as assigned.

Qualifications and Education Requirements

• Certified Pharmacy Technician (CPhT) with active certification.

• 2+ years of experience in a retail pharmacy, PBM and/or other managed care organization

• Proficiency in Microsoft Office Professional suite.

• Project management skills.

• Excellent organizational, written and verbal communication.

• Familiarity with clinical programs, including weight loss.

• Ability to adapt and perform duties efficiently whenever unexpected changes arise

Preferences

• Bachelor of Arts or Science degree from accredited college

• Solid understanding of PBM Operations including claims submission and processing, and familiarity with medications and their uses.

• Knowledge of HIPAA regulations

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.

What We Do
LucyRx is an independent, next-generation pharmacy benefits manager (PBM) transforming how healthcare works. We're fixing what's broken in the PBM industry by putting people first and challenging outdated norms. For too long, traditional PBMs have prioritized profit over patients, and we believe that's just plain wrong.

LucyRx offers bold, innovative solutions powered by LucyIQ, our proprietary AI platform, to deliver actionable insights that lower costs, improve care, and simplify prescription management.

While we're new to the PBM space, LucyRx is built on decades of leadership experience and a commitment to meaningful change. We're a nimble, remote-first team with a bold mission to redefine pharmacy benefits-and we're just getting started.

What It's Like to Work at LucyRx
At LucyRx, we're a fast-moving team dedicated to making healthcare simpler, fairer, and more effective. Joining us means being part of a dynamic, mission-driven group that works collaboratively to challenge outdated industry practices and redefine what's possible in pharmacy benefits.

We value accountability, innovation, and a relentless focus on making an impact. Here, you'll find a supportive culture that encourages you to bring your whole self to work, share bold ideas, and grow alongside smart, driven colleagues who are passionate about fixing the PBM industry. If you're ready to roll up your sleeves and make a real difference, we'd love to have you on our team.

Salary:

$20.00-$25.00 per hour