Coverage Determination Jobs (NOW HIRING)

Job Title: Remote Pharmacy Technician

Job Description

This remote Pharmacy Technician position focuses on reviewing pharmacy prior authorization requests and supporting coverage determinations for a large healthcare insurance organization. You will evaluate requests for a wide range of medications and health plans, approve or deny based on established criteria, and route decisions to a pharmacist for final review. The role offers minimal phone work, long-term career potential, and the opportunity to transition to a permanent position with benefits in a professional, nationwide healthcare environment.

Responsibilities

• Review prior authorization requests for prescription medications across multiple health plans and drug types.

• Evaluate coverage determination requests using established clinical and plan criteria and document clear approval or denial decisions.

• Enter all decisions and related information accurately into the pharmacy benefit management (PBM) system.

• Route completed coverage determinations to a pharmacist for final review and sign-off.

• Track and monitor coverage determination requests from receipt through final decision to ensure timely processing.

• Obtain verbal authorizations from prescribers or their offices when required.

• Request and collect detailed clinical information from prescribers to support coverage decisions.

• Notify providers and members of decision outcomes in a clear and timely manner.

• Respond to client and provider inquiries related to prior authorization requests and prescription benefit coverage.

• Refer requests involving specialty medications or complex therapies to the appropriate specialty pharmacy or internal team.

• Contact providers or their staff to clarify information or obtain missing documentation needed for coverage determination.

• Assist with inbound and outbound patient or physician calls as needed, while maintaining a primarily non-phone-based workload.

• Use multiple computer systems and screens simultaneously to research, process, and document prior authorization cases.

• Maintain accurate, thorough, and compliant documentation for all interactions and decisions in the appropriate systems.

• Follow all applicable pharmacy regulations, internal policies, and procedures related to prior authorizations and prescription benefits.

• Meet established productivity, quality, and turnaround time metrics while maintaining strong attention to detail.

• Collaborate with pharmacists, pharmacy technicians, and other team members to support seamless prior authorization operations.

• Participate in training, coaching, and ongoing education to stay current with plan criteria, systems, and processes.

Essential Skills

• High school diploma or GED.

• Current registration as a pharmacy technician in the state of residence.

• National pharmacy technician certification (such as PTCB or NHA).

• Active pharmacy technician license and registration as required by the state of operation.

• Pharmacy technician certification (e.g., Certified Pharmacy Technician, Registered Pharmacy Technician).

• Experience as a pharmacy technician in environments such as retail pharmacy, hospital pharmacy, PBM, call center, or specialty pharmacy.

• Familiarity with prior authorization processes and coverage determination for prescription benefits.

• Basic to strong computer skills, including proficiency with Microsoft Office, Outlook, and data entry.

• Ability to work efficiently within multiple computer systems and on multiple screens.

• Strong attention to detail and accuracy in data entry and documentation.

• Ability to interpret and apply coverage criteria and clinical information to prior authorization requests.

• Customer service skills for interacting with providers, members, and internal stakeholders.

• Ability to work scheduled shifts Monday through Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, including rotating weekends and some holidays.

• Reliable high-speed internet (Wi-Fi) and the ability to maintain a dedicated workspace with a closing door for privacy and focus.

Additional Skills & Qualifications

• Experience working with prescription benefit management (PBM) systems and prescription benefit coverage.

• Experience in Medicare and Medicaid prescription benefits.

• Experience in call center environments handling healthcare or pharmacy-related inquiries.

• Prior work in specialty pharmacy or handling specialty medications.

• Strong typing and data entry skills with the ability to manage high volumes of electronic requests.

• Ability to manage minimal phone work, primarily outbound calls to providers and prescribers when needed.

• Comfort working in a structured, metric-driven environment with performance expectations.

• Interest in long-term career growth within a large, nationwide healthcare organization.

• Desire to transition from contract to permanent employment, with access to benefits and paid time off upon conversion.

Work Environment

This role operates in a fully remote, professional environment aligned with Eastern Standard Time for training and operations. Training runs from 10:00 a.m. to 6:30 p.m. EST, after which you receive a regular schedule. You must be available Monday through Friday between 8:00 a.m. and 8:00 p.m. in your local time zone, with participation in a rotating weekend schedule approximately every 4–6 weeks and the ability to work some holidays.

Job Type & Location

This is a Contract to Hire position based out of Cleveland, OH.

Pay and Benefits

The pay range for this position is $20.00 - $23.00/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)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Aug 14, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.