Senior Clinical Pharmacy Technician – Medi-Cal Rx

Prime Therapeutics

Senior pharmacy technician managing Medi-Cal Rx prior authorizations, eligibility, benefits, and claims for Prime Therapeutics, a pharmacy benefit manager. Supporting providers, members, pharmacists, and team workflow improvements.

Posted 8/7/2026full-timeRemote • California • 🇺🇸 United StatesSenior💰 $19 - $29 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in pharmacy workflows, reimbursement processes, and prior authorization management while effectively communicating with providers and team members. Proficient in utilizing pharmacy systems and Microsoft Office applications to support case management and process improvements.

Highest-signal resume keywords

Licensed Pharmacy TechnicianPharmacy Workflows KnowledgeReimbursement Processes ExpertiseEffective Communication SkillsCase Management Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ManagementClaims Submission ProcessesEligibility and Benefits ReviewDocumentation and Case ContextProcess Improvement IdentificationPharmacy Systems ProficiencyMicrosoft Office Applications

Soft Skills

Team Support and GuidanceAbility to Prioritize WorkDynamic Environment Adaptability

Certifications & Qualifications

Licensed Pharmacy Technician

Industry Keywords

Pharmacy TechnicianReimbursement ExperiencePBM ExperienceHealth Care ExperienceClaims Management

About the role

Key responsibilities & impact

Independently review, research, and resolve prior authorization requests using clinical criteria, established guidelines, and professional judgment within defined protocols
Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders
Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations
Escalate clinically complex or exception-based cases to a pharmacist with thorough documentation and relevant case context
Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks
Initiate, prioritize, and manage cases by accurately gathering and entering member and provider information
Identify trends, root causes, high-risk inquiries, and workflow gaps, and recommend process improvements
Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities
Perform other duties as assigned

Requirements

What you’ll need

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 work visa or residency sponsorship
Strong knowledge of pharmacy workflows, terminology, and reimbursement processes
Ability to prioritize work and manage multiple assignments in a dynamic environment
Effective communication skills and ability to guide and support team members
Proficiency in pharmacy systems and Microsoft Office applications
Preferred: 1 year reimbursement experience
Preferred: PBM or health care experience
Must comply with job-specific security responsibilities, controls, legal, regulatory, contractual, and internal requirements
Must be able to perform the essential functions of the job

Benefits

Comp & perks

Benefits, incentives, and additional compensation are available; the posting directs applicants to Prime’s Benefits Page for details
Reasonable accommodations for employees with disabilities
Equal opportunity and affirmative action employment
Tobacco-Free Workplace