prior authorization technician.

We are looking for a Prior Authorization Technician (RX) to join our Clinical Department. In this role, you aren’t just processing paperwork, you are the vital link between patients and the life-changing medications they need. Working directly under the guidance of Clinical Pharmacists, you will use your expertise to navigate complex pharmacy benefits, ensure clinical accuracy, and advocate for timely patient care. What We’re Looking For:

• High level understanding of medical/pharmacy terminology and formulary structures.
  
  
• Ability to balance high-volume productivity with extreme attention to detail.
  
  
• Excellent verbal and written communication skills for interacting with healthcare providers and internal departments.
  
  
• Licensed Pharmacy Technician (CPhT highly Preferred / Will consider applicants with State license/registrations that have 3+ years of experience)   
  
  

Your clinical expertise can help to change a patient's life! If you’re a HIPAA savvy pro with an eye for detail and 3+ years working in pharmaceutical setting, we want to meet you! Please apply today!

salary: $20 - $22 per hour
shift: First
work hours: 8 AM - 5:30 PM
education: High School

Responsibilities

• Processing: Initiate, research, and resolve prior authorization requests and appeals within automated systems, ensuring all productivity and quality metrics are met.
  
  
• Clinical Determination: Interpret pharmacy benefit coverage, clinical criteria, and formulary alternatives to provide accurate determinations.
  
  
• Professional Liaison: Serve as the primary point of contact for members and providers regarding prior auth status, inquiries, and grievances.
  
  
• Documentation & Reporting: Meticulously document all outcomes and assist in generating program statistics and key performance metrics for management.
  
  
• Clinical Escalation: Identify and escalate complex cases requiring extensive clinical review or potential denial to the Clinical Pharmacist.
  
  
• Process Improvement: Assist in developing departmental procedures, training materials, and desk-level documentation as systems evolve.
  
  

Compliance & Quality

• Strictly adhere to all HIPAA regulations regarding Protected Health Information (PHI).
  
  
• Maintain a high level of accuracy and demonstrate competency in all required clinical and compliance training.
  
  
• Remain adaptable to shifting priorities and new responsibilities as assigned by the Clinical Manager.
  
  

Skills

Pharmaceutical

CpHT

Pharmacy Technician

HIPAA

PHI

Healthcare

Prior Authorizations

Confidentiality

Pharmacy Tech Certification

Qualifications

Years of experience: 3 years

Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.