Express Scripts Prior Authorization Jobs in California

This is a full-time position with 8-hour VARIED shifts, generally Monday through Friday located at Mercy San Diego in Hillcrest.

Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide.

Why join Scripps Health?

At Scripps Health, your ambition is empowered and your abilities are appreciated:

• Nearly a quarter of our employees have been with Scripps Health for over 10 years.
• Scripps is a Great Place to Work Certified company for 2025.
• Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
• Beckers Healthcare ranked Scripps Health on its 2024 list of 150 top places to work in health care.
• We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.
• Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.

Why join this team?

The Pharmacy Technician Specialist will provide essential support to both the Ambulatory and Specialty Pharmacies at Scripps Health. Our ambulatory pharmacies offer a range of services, including filling new and refill prescriptions, managing specialty medications, and transferring existing prescriptions from inpatient pharmacies to our three convenient Scripps Pharmacy locations. The Scripps Health Specialty Pharmacy is dedicated to delivering the highest standard of pharmacy services and personalized patient care, supporting individuals with complex medical conditions. Through our comprehensive Specialty Pharmacy program, we collaborate with patients' insurance providers, arrange for direct medication delivery to their homes, and conduct regular follow-ups to provide ongoing monitoring and support.

Our team, composed of friendly, knowledgeable, and highly trained pharmacists and support staff, plays a critical role in providing high quality patient care. By managing medication therapies, offering clinical consultations, and providing tailored support for specialty medications, we ensure patients receive the care they need. This role will also involve close collaboration with healthcare providers, patients, and insurance companies to facilitate seamless medication access and promote adherence.

Responsibilities include:

• Supporting outpatient specialty and ambulatory pharmacy services by completing benefits investigations, coordinating prior authorizations and appeals, and ensuring timely patient access to therapy. 
• Managing first fills and refills, delivery logistics, and collaboration with manufacturer hubs and financial assistance programs to streamline onboarding. 
• Providing proactive patient outreach, triages need, scheduling refills, monitoring adherence, and coordinating clinic visits and labs. 
• Overseeing referral processing, inventory, and purchasing while maintaining regulatory and accreditation compliance. 

• Assisting with staff training and workflow optimization, requiring strong communication skills, attention to detail, and expertise in complex payer and medication processes.

Required Experience/Specialized Skills:

• High school diploma or equivalent.
• Advanced knowledge of specialty-drug formularies, payer prior authorization (PA) & appeal portals (e.g. CoverMyMeds, Optum, CVS Caremark, Express Scripts), ICD-10/CPT/HCPCS coding, REMS programs, and limited-distribution drug networks as appropriate to the role.
• Proficiency with EMR systems (Epic preferred), payer websites, Microsoft Office, and workflow proficiency in area of practice.
• Experience in inventory management, purchasing processes, and maintaining compliance with storage, handling and ordering standards for specialty medications.

• Excellent written/verbal communication, critical-thinking, and customer service skills.

Required Certification/Registration:

• Current Pharmacy Technician License.
• Certification by a National Pharmacy Technician Certification Board (CPhT) required within 6 months of hire.

• Minimum 2 years pharmacy technician experience with at least one year in practice area.

Preferred Qualifications:

• 5 years combined inpatient/outpatient or specialty pharmacy experience 
• CPhT