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

Job Description

The Senior Clinical Pharmacy Technician assists with complex care coordination as it relates to pharmacy benefits for New York Medicaid members. Efforts may include claim submission, coverage parameters, and/or prior authorization requests. Additional outreach efforts may be needed to educate providers on NYRx, the Medicaid Pharmacy Program.

Responsibilities

• Evaluate and process prior authorization (PA) requests, including determining medication appropriateness, applying clinical criteria, and communicating decisions to providers, pharmacies, and internal stakeholders.
• Research, resolve, and document PA outcomes and complex provider/member inquiries while ensuring accuracy and compliance with system and documentation standards.
• Lead complex care coordination efforts for New York Medicaid members, including inbound and outbound provider outreach, claim resolution, coverage clarification, and facilitation of prior authorizations to support continuity of care.
• Provide guidance and education to providers on formulary coverage, NYRx program requirements, prior authorization processes, and therapeutic alternatives.
• Escalate cases requiring additional clinical review or denial to a pharmacist in accordance with established protocols.
• Deliver high-quality customer service while meeting performance-, accuracy-, and service-level expectations.

Minimum Qualifications

• High school diploma from an accredited school or equivalent GED

• 2 years of work experience as a pharmacy technician
• Required CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

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

Additional Qualifications

• Strong knowledge of specialty injectable prescription drugs, disease states, formulary management techniques, medical terminology, and reimbursement coding practices
• Proficiency in pharmacy systems, software applications, and Microsoft Office products
• Excellent written and verbal communication skills
• Ability to interpret and apply established clinical criteria and operational procedures
• Ability to identify, troubleshoot, and resolve operational issues

Preferred Qualifications

• Specialty pharmacy, retail pharmacy, reimbursement, or health plan experience
• 2+ years of Customer Service experience
• Complex care coordination 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 (https://www.primetherapeutics.com/benefits).

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.