PBM Prior Authorization Technician

JOB TITLE: Prior Authorization Technician

DATE: September 2026

REPORTS TO: Clinical Services Director, MaxCare FLSA STATUS: Non-Exempt

JOB SUMMARY:

The Prior Authorization (Clinical) Technician assists the clinical pharmacist with clinical programs within MaxCare, including timely operation of the daily prior-authorization workflow, drug formulary updates, maintenance of clinical program utilization, and production of clinical materials, while supporting responses to client clinical inquiries.

ESSENTIAL JOB FUNCTIONS:

Prior Authorization Workflow

• Manage the daily workflow of prior authorizations to ensure reviews meet national, state, and internal MaxCare standards.
• Assist the clinical team in developing and maintaining drug utilization management programs and policies (appeals, quantity limits, step therapies, age/gender limits, prior authorizations, and other clinical programs).

Client & Cross-Functional Support

• Work with the account management and sales team to provide clinical program consultation and effective client recommendations.
• Collaborate with clients and account managers to design custom benefit management programs, including cost-savings analysis, claims-data analysis, and clinical recommendations.
• Produce MaxAlert pharmacy alerts for internal and external distribution.

Quality & Goals

• Employ continuous quality improvement (CQI) to improve the efficiency and effectiveness of the drug utilization management process.
• Create individual strategic goals annually to align with MaxCare's strategic goals, mission, and vision.

ADDITIONAL RESPONSIBILITIES:

• Assist in the training and mentoring of pharmacy students, interns, and/or residents.
• Perform other duties and activities as determined by the Senior Vice President or Clinical Services Director.

MINIMUM QUALIFICATIONS FOR CONSIDERATION:

• EDUCATION
• High school diploma or equivalent; undergraduate or higher education preferred.
• EXPERIENCE
• Strong clinical background in PBM, managed care, and/or clinical practice settings.
• Two years of experience in managed care and/or clinical practice settings.
• Specialized accreditation
• Active pharmacy technician licensure in good standing with the Oklahoma State Board of Pharmacy, no restrictions.
• National pharmacy technician certification (PTCB) recommended.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Familiarity with prescription benefits claims processing and formulary design.
• Knowledge of drug data systems (e.g., Medi-Span, First Databank, AHFS).
• Compelling customer-service orientation and commitment to professionalism.
• Proficiency in PC applications, including Microsoft Office.
• Sophisticated verbal and written communication skills.
• Highly developed organizational and time-management skills.
• Outstanding interpersonal, problem-solving, and analytical skills.
• Works collaboratively in a team environment.
• Resourcefulness and initiative within designated timelines.

PHYSICAL REQUIREMENTS

This work is sedentary and may involve occasional bending, squatting, kneeling, and stooping. It requires good finger dexterity, feeling, and frequent repetitive motions, as well as the ability to talk, hear, and maintain visual acuity. Occasional travel to client locations and other sites may be required.

WORKING CONDITIONS:

• Office environment.
• Remote work environment: This position is eligible for remote work based on remote work qualifications and maintaining high quality productivity.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

COMPANY DESCRIPTION:

MaxCare Prescription Benefit Services is redefining pharmacy benefit management. We provide clients with the knowledge, clarity of options and flexibility they need to effectively manage pharmacy benefits. We focus on developing programs, services and processes that are clinically based, member-focused, and aligned for all stakeholders. MaxCare delivers an innovative mix of market expertise, information technology, and specialty pharmacy offerings. We serve the needs of health plans, unions, third-party administrators (TPAs) and self-insured employers.

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

Pay: $20.46 - $22.27 per hour

Expected hours: 37.5 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Application Question(s):

• Describe your prior authorization experience.

Education:

• Bachelor's (Preferred)

Experience:

• Technician: 3 years (Required)

License/Certification:

• PTCB Certification (Required)

Work Location: Remote