Senior Clinical Operations Technician

Job Summary

Serving as a technical resource, the full-time Senior Clinical Operations Technician will process and track complex requests for formulary exceptions and prior authorizations while providing support to internal reviewers and managing escalated inquiries.

Key responsibilities

• Act as a point of contact for internal reviewers, providing guidance and support for complex case scenarios
• Respond to escalated calls from the Contact Center and providers, ensuring accurate information and thorough documentation
• Review clinical criteria and manage prior authorizations in claims and UM systems to ensure accurate processing

Required qualifications

• High school diploma or equivalent GED
• 2 years of pharmacy or health care delivery experience
• Eligibility to work in the United States without the need for work visa or residency sponsorship
• Basic math skills and general PC knowledge, including Microsoft Office
• Ability to work a flexible schedule, including weekends and holidays