Clinical Pharmacy Technician Sr - Medi-Cal Rx

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Clinical Pharmacy Technician Sr - Medi-Cal Rx Job Description

The Senior Clinical Pharmacy Technician – Medi-Cal independently manages prior authorization requests, eligibility, pharmacy benefits, and claims using established clinical criteria. This role serves as a technical resource to team members, supports resolution of non-routine cases, and identifies opportunities to improve workflow efficiency.

Responsibilities

Independently review, research, and resolve prior authorization requests by applying clinical criteria, established guidelines, and professional judgment within defined protocols

Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring clarity and accuracy in non-routine scenarios

Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations, resolving moderately complex issues and determining appropriate next steps

Escalate clinically complex or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support timely resolution

Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks

Initiates, prioritize, and manage cases by accurately gathering and entering member and provider information

Identify trends, root causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, quality, and consistency

Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities

Minimum Qualifications

High school diploma from an accredited school or equivalent GED

2 years of work experience as a pharmacy technician

Licensed Pharmacy Technician in accordance with California state requirements

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

Strong knowledge of pharmacy workflows, terminology, and reimbursement processes

Ability to prioritize work and manage multiple assignments in a dynamic environment

Effective communication skills with the ability to guide and support team members

Proficiency in pharmacy systems and Microsoft Office applications

Preferred Qualifications

1 year reimbursement experience

PBM or health care experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Originally posted on Himalayas