Join our Prior Authorization Operations team where you will play a crucial role in processing prior authorization requests. You will ensure accuracy, timeliness, and productivity while adhering to client performance commitments. Utilize various business applications to perform analysis, obtain information, and enter data necessary for claims adjudication. This position requires strong reasoning skills to identify missing information and make determinations based on clinical protocols and guidelines. You will interact with both internal and external customers to provide and obtain information, ensuring the delivery of outstanding service and quality.
ResponsibilitiesProcess and finalize prior authorization requests within clients’ turnaround time and performance guarantees using established guidelines.Enter prior authorizations into the system, prioritize requests, and check formulary alternatives.Review tried and failed medications and apply prior authorization guidelines.Utilize drug references and verify the drug being requested is indicated and approved for the condition.Document all related information regarding the prior authorization approval or non-approval.Respond to incoming requests via phone, fax, ePA, and return status of the prior authorization to physicians and pharmacies.Conform to defined roles and responsibilities and rules of engagement between prior authorization processing and clinical decision making.Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.Achieve prior authorization processing productivity and accuracy standards.Analyze, research, and resolve prior authorization processing issues as appropriate for experience and career path level.Coordinate notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations.Document prior authorization-related information and status.Make outbound calls to obtain information and answer questions about prior authorization status.Collaborate with MCO and Self-Insured client teams to understand PBM clients’ prior authorization processing requirements and expectations.Collaborate with Contact Center Services in resolving prior authorization inquiries and handling incoming calls during periods of high volume.Protect and maintain confidentiality and privacy of all prior authorization and member information.
Essential SkillsCertified Pharmacy Technician (CPhT)At least 1 year of prior remote prior authorizations experienceActive license in state of residenceMinimum of 3 years of pharmacy technician experienceUnderstanding of managed pharmacy benefit concepts including formulas, prior authorizations, edits, and claim adjudicationWorking knowledge of customer service in a retail/outpatient pharmacy environmentFamiliarity with pharmacy software data submission requirements such as CovermyMeds or Electronic Prior Authorization (e-PA)Intermediate knowledge of MS Office/Word, Excel, and OutlookExperience with Windows-based database programs
Additional Skills & QualificationsIdeal tenure of at least 2 years/role (exceptions can be made for relocating, store closure, etc.)Aptitude for new programs
Work Environment
This is a remote position requiring a quiet workspace and a high-speed internet connection. Candidates must reside in either the MST or PST time zones. The work schedule is from 8 am to 6 pm PST. Enjoy the benefits of a robust training program, medical/dental/vision coverage, wellness programs, paid time off, company-paid holidays, incentive compensation, 401K with company match, life and disability insurance, tuition reimbursement, and an employee referral bonus. There is a high success rate of conversion, and many consultants receive positive feedback and have opportunities for advancement.
Job Type & Location
This is a Contract to Hire position based out of Tempe, Arizona.
Pay and Benefits
The pay range for this position is $23.50 - $23.50/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 Sep 22, 2025.
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 for other accommodation options.