As a Pharmacy Technician, you will be responsible for coverage determination requests submitted by providers and determining whether a pharmacist review is required. You will play a key role in obtaining verbal authorizations, requesting detailed clinical information from prescribers, and approving coverage determination requests based on defined criteria.
Responsibilities
Approve coverage determination requests based on defined criteria.
Enter and document coverage determination request decisions into the PBM system.
Notify providers and/or members of coverage determination request decisions.
Respond to client inquiries regarding authorization approvals and PBM online applications.
Refer coverage determination requests for specialty drugs to delegated vendor or client for processing.
Contact providers for additional information to facilitate coverage determination reviews.
Notify physicians, providers, and members of coverage determination request decisions.
Essential Skills
Prior authorization experience.
Data entry proficiency.
Pharmacy technician license.
Pharmacy experience, preferably in a retail setting.
Strong computer skills.
Additional Skills & Qualifications
Experience with Microsoft applications.
Knowledge of managed care systems.
Familiarity with Medicare/Medicaid processes.
Work Environment
This is a 100% remote work environment.
Your start time can range as early as 8am EST but not later than 10am EST, with an hour lunch break.
The training schedule is from 10am to 6:30pm EST, Monday through Friday, with a 30-minute unpaid lunch.
You will also be required to work rotating weekends every 4-6 weeks.
Job Type & Location
This is a Contract to Hire position based out of Mammoth Cave, KY.
Pay and Benefits
The pay range for this position is $18.00 - $20.00/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 Jan 23, 2026.
FOR THIS TYPE OF EMPLOYMENT STATE LAW REQUIRES A CRIMINAL RECORD CHECK AS A CONDITION OF EMPLOYMENT.
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 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
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 due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
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