Remote Initial Review Pharmacy Technician – Specialty Medication Utilization Management & Clinical Review Specialist (Work‑From‑Home)

Welcome to Workwarp – Pioneering Remote Healthcare Solutions

At Workwarp, we believe that exceptional patient outcomes begin with empowered, knowledgeable professionals who can operate from anywhere. As a trusted partner of Prime Therapeutics, we deliver cutting‑edge utilization management services that shape the future of specialty pharmacy care. Our remote workforce is at the heart of this transformation, providing flexible, high‑impact support to health plans, providers, and patients across the nation. If you thrive in a fast‑paced, technology‑driven environment and are passionate about ensuring the right medication gets to the right patient at the right time, this role is your next career milestone.

Why This Role Matters – The Bigger Picture

The Remote Initial Review Pharmacy Technician sits at the critical intersection of clinical expertise, regulatory compliance, and customer service excellence. You will be the first line of defense in evaluating therapeutic appropriateness for high‑cost specialty medications, safeguarding both the health plan’s resources and, more importantly, patient safety. By leveraging evidence‑based criteria and engaging directly with prescribers, patients, and pharmacies, you help streamline prior authorization processes, enhance medication adherence, and contribute to overall program integrity.

Key Responsibilities – What You’ll Do Every Day

• Clinical Review & Approval: Examine prospective and retrospective medication requests, applying detailed clinical criteria to determine appropriateness. Document your findings and issue approval recommendations for all services that meet the established standards.
• Escalation Management: Identify cases that fall outside of clinical criteria and promptly refer them to a pharmacist clinical reviewer for further evaluation.
• Utilization Management Adherence: Consistently practice the principles of utilization management by following Workwarp’s policies, NCQA guidelines, and health‑plan specific procedures.
• Ongoing Training & Knowledge Maintenance: Participate in regular training sessions on new specialty medications, therapeutic classes, and evolving regulatory requirements to preserve clinical integrity.
• Program Integrity Audits: Conduct comprehensive audits that involve outreach, medical record review, and verification of provider responses during prior authorizations. Summarize findings and report results to clients for continuous improvement.
• Documentation & Communication: Craft clear, concise written and verbal communications to physicians, prescribers, and pharmacy staff. Ensure all edits, data elements, and correspondence are accurately captured in the electronic system.
• Consultation & Issue Resolution: Serve as a subject‑matter expert for pharmacy‑related queries, assisting internal teams and external partners in resolving claim submission challenges.
• Physician Outreach: Proactively contact prescribers to obtain missing clinical history, clarify medication intent, and secure any additional documentation required for a thorough review.
• Customer Service Excellence: Deliver timely, professional, and empathetic support to all stakeholders, adhering to required turnaround times and maintaining a high satisfaction rating.
• Outlier Monitoring: Review and analyze pended claims flagged as outliers by internal analytics or external audits, identifying trends and recommending corrective actions.
• Intake & Order Support: Provide backup for high call‑volume periods, assisting with intake, order entry, and eligibility verification as needed.
• Eligibility Determination: Apply clinical criteria to assess medication reimbursement eligibility, ensuring compliance with formulary and benefit design.
• Electronic Documentation: Record all interactions with physicians, staff, cardholders, and pharmacies in the system, preserving a complete audit trail.
• Medical Exception Escalation: When further clinical review is required, elevate medical exception requests to the nurse, pharmacist, or physician on the utilization review team.

Essential Qualifications – What You Must Bring

• Active Pharmacy Technician Licensure or Registration: Must hold a current state‑required license or registration. If your state does not mandate a license, a national certification (PTCB or ExCPT) is required.
• Two Years Minimum Pharmacy Experience: This can be achieved without a bachelor’s degree, or with a bachelor’s degree in a science, health, or related field combined with two years of experience.
• Specialty or Retail Pharmacy Background: Direct exposure to specialty injectable drugs, oncology pharmacy, or a health‑plan environment is highly valued.
• Utilization Management or High‑Volume Call‑Center Experience: Proven ability to thrive in fast‑paced, multi‑functional environments while maintaining accuracy and compliance.
• Technical Proficiency: Comfortable navigating computer systems, Microsoft Office, and learning proprietary software quickly.
• Communication Mastery: Excellent verbal and written skills, with a talent for building rapport with physicians, prescribers, and internal stakeholders.
• Analytical Acumen: Ability to interpret clinical data, translate findings into actionable recommendations, and document decisions clearly.
• Knowledge of Specialty Medications: Deep understanding of disease states, formulary management, and medical terminology, especially within oncology or other high‑complexity therapeutic areas.
• Team‑Oriented Mindset: Demonstrated respect for cross‑functional collaboration and dedication to shared goals.

Preferred (Nice‑to‑Have) Qualifications

• Four or more years of cumulative pharmacy experience.
• Previous experience in reimbursement or prior‑authorization processes.
• Additional certification(s) such as Certified Pharmacy Technician (CPhT) or Advanced Pharmacy Technician (APhT).
• Familiarity with NCQA accreditation standards and health‑plan specific guidelines.
• Experience with audit software, data analytics tools, or quality‑improvement initiatives.

Core Skills & Competencies for Success

• Clinical Judgment: Apply evidence‑based criteria to assess therapeutic appropriateness.
• Detail‑Oriented Documentation: Maintain precise electronic records that support compliance audits.
• Effective Time Management: Prioritize high‑volume workloads while meeting strict turnaround metrics.
• Empathy & Customer Focus: Deliver compassionate communication that respects providers and patients alike.
• Problem‑Solving: Identify root causes of claim issues and propose pragmatic solutions.
• Adaptability: Embrace new medication classes, regulatory updates, and evolving technology platforms.
• Collaboration: Work seamlessly with clinical, operations, reporting, and IT teams to achieve shared objectives.

Career Growth & Professional Development

At Workwarp, your development is a priority. We invest in our remote workforce through a robust learning ecosystem that includes:

• Structured Training Programs: Onboarding curricula covering specialty medications, utilization management fundamentals, and regulatory compliance.
• Continuous Education: Access to webinars, industry conferences, and tuition reimbursement for advanced certifications or degree programs.
• Mentorship Opportunities: Pairing with senior pharmacists or clinical reviewers to deepen clinical expertise.
• Clear Career Pathways: Progression from Initial Review Technician to Senior Review Specialist, Clinical Operations Analyst, or Pharmacy Services Manager.
• Performance‑Based Incentives: Recognition programs that reward accuracy, efficiency, and innovative contributions.

Our Remote Work Culture – What Sets Us Apart

Working from home at Workwarp isn’t just about flexibility; it’s about belonging to a vibrant, purpose‑driven community.

• Inclusive Environment: We celebrate diverse perspectives and encourage open dialogue across all levels.
• Virtual Collaboration: Regular team huddles, video‑conferences, and digital coffee chats keep connections strong.
• Work‑Life Integration: Flexible scheduling, generous paid time off, and a supportive management team help you maintain balance.
• Technology‑First Approach: State‑of‑the‑art platforms enable seamless workflow, secure data handling, and real‑time communication.
• Recognition & Celebration: Quarterly awards, peer‑nominated honors, and virtual celebrations recognize your hard work.

Compensation, Benefits & Perks

We offer a competitive total rewards package that reflects your experience, skill set, and the value you bring to our organization.

• Salary Range: $22.84 – $34.25 per hour, commensurate with experience and certifications.
• Health Coverage: Comprehensive medical, dental, and vision plans with employer contributions.
• Retirement Savings: 401(k) plan with company matching to help you build a secure financial future.
• Paid Time Off & Holidays: Generous PTO accrual, paid holidays, and additional leave for continued education or life events.
• Tuition Reimbursement: Support for pursuing further education, certifications, or advanced degrees.
• Professional Development: Access to industry certifications, training workshops, and leadership development programs.
• Employee Discounts: Savings on a variety of health‑related products and services.
• Remote‑Work Stipend: A monthly allowance for home office essentials, internet, and ergonomic equipment.

How to Apply – Take the Next Step in Your Career

If you are ready to make a meaningful impact on patient care while enjoying the freedom of a remote role, we want to hear from you. Click the link below to submit your application, resume, and a brief cover letter outlining why you’re the perfect fit for this position.

Apply Now – Join Workwarp’s Remote Pharmacy Team

Your Future Starts Here

Don’t let this opportunity pass you by. At Workwarp, we are shaping the future of specialty pharmacy utilization—one medication review at a time. Join us, grow your expertise, and help ensure patients receive the right therapies, when they need them most.