Central Prior Authorization Pharmacy Technician - Cincinnati, OH

Job Description

The Central Prior Authorization (PA) Pharmacy Technician II provides support to pharmacists and managers in all aspects of providing pharmacy services. Under the general supervision of the Assistant Director of Pharmacy, and according to standard procedure, the Central PA Pharmacy Technician II completes prior authorizations upon receiving orders from a licensed practitioner, and performs all duties necessary to support the effective daily operation of all departmental services and programs.

Responsibilities

Views & Evaluates PA Requests

• Analyzes PA submissions from providers to ensure they meet clinical and formulary guidelines.
• Reviews patient history, lab results, and diagnosis codes when available.
• Assesses medical necessity based on criteria such as FDA-approved indications, compendia, and internal policies.

Applies Clinical Criteria

• Uses evidence-based guidelines (e.g., Medicare Part D, NCCN, IDSA, ADA) to determine approval or denial.
• Identifies off-label use and evaluates its appropriateness.

Communicates with Providers

• Requests additional documentation or clarification when needed.
• Explains coverage decisions and educate on formulary alternatives or step therapy requirements.

Documents & Processes Authorizations

• Enters decisions into pharmacy benefit management (PBM) or health plan systems.
• Ensures accurate record-keeping for compliance and audit purposes.

Collaborates with Internal Teams

• Works with case managers, medical directors, and utilization review teams.
• Participates in interdisciplinary discussions about complex or high-cost cases.

Monitors for Compliance & Fraud

• Identifies potential overuse, misuse, or inappropriate prescribing patterns.
• Flags questionable cases for further investigation.

Maintains Up-to-Date Knowledge

• Stays current on formularies, new drug approvals, clinical guidelines, and payer policies.
• Attends continuing education and internal training sessions.

Supports Appeals Process

• Prepares clinical rationales for appeal responses in conjunction with a pharmacist.
• Reviews new evidence submitted during appeal reviews.

Provides Education

• Educates prescribers, patients, and internal staff about prior authorization processes and criteria.
• Helps reduce PA burden through proactive outreach and education on preferred alternatives.

Quality Assurance & Process Improvement

• Participates in audits and contributes to quality improvement initiatives.
• Helps streamline workflows and improve efficiency in the PA process.

Other Duties

• Performs Pharmacy Technician II duties and responsibilities in other areas across the network including but not limited to the retail, inpatient, and ambulatory pharmacy departments as needed.
• As a representative of The Christ Hospital Health Network and Department of Pharmacy Services, promotes a positive image in all dealings with all other hospital associates and hospital customers.
• Performs other duties as deemed necessary by the Director of Pharmacy, Assistant Director, and pharmacists.

Qualifications

EDUCATION: High school diploma or GED required.

YEARS OF EXPERIENCE: A minimum of 2 years of pharmacy technician experience required. Retail pharmacy or ambulatory care experience preferred.

REQUIRED SKILLS AND KNOWLEDGE

• Must meet all minimum qualifications for a Central PA Pharmacy Technician I
• A work history of qualitative consistency, productivity and appropriate independence.
• A work history of initiative, motivation and flexibility.
• A work history of above average quality, quantity and knowledge of work.
• A work history of above average attendance and reliability.

LICENSES REGISTRATIONS &/or CERTIFICATIONS

• Ohio State Board of Pharmacy Technician Registration Required
• Certified Pharmacy Technician (PTCB/CPhT) certification required.
• Must keep active PTCB/CPhT certification and registration with the Ohio State Board of Pharmacy for duration of employment as a Pharmacy Technician.