Certified Pharmacy Technician - Remote US

Summary

Join Gainwell as a Certified Pharmacy Technician (CPhT) and support Rhode Island Medicaid and other state pharmacy programs through pharmacy claims, prior authorization, provider support, eligibility, formulary, and program operations. In this fully remote role, you will work closely with state agency personnel, providers, pharmacies, and internal teams to research and resolve pharmacy-related issues and support accurate program administration. This opportunity is ideal for an experienced Certified Pharmacy Technician with managed care, PBM, health plan, or pharmacy-benefit experience who is comfortable serving as a pharmacy program resource.

Your role in our mission

• Maintain day-to-day relationships with state agency personnel while supporting eligibility updates, reporting, formulary activities, and prior authorization support.
• Support state agency pharmacy programs, policies, processes, and reporting requirements, including POS and HCPCS adjudication related to medication prior authorizations.
• Review, research, and process pharmacy prior authorization requests in accordance with established criteria, policies, regulatory requirements, FDA guidance, and service-level expectations.
• Research and resolve program, member, provider, and pharmacy inquiries, including provider enrollment questions involving limited distribution drugs, while documenting activity accurately.
• Partner with internal departments on pharmacy initiatives, provide pharmacy program subject-matter expertise, and help identify opportunities to improve quality and operational performance.

What we're looking for

• Active Certified Pharmacy Technician credential (PTCB/CPhT, ExCPT, or equivalent) required.
• Two or more years of relevant pharmacy technician experience, preferably within managed care, health insurance, PBM, pharmacy benefits, Medicaid, or a related healthcare environment.
• Experience with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider, or pharmacy support.
• Experience with POS claims, HCPCS, provider enrollment, formularies, eligibility, or related pharmacy program operations is highly desirable.
• Strong communication, research, problem-solving, computer, and organizational skills with the ability to navigate multiple systems in a fast-paced remote environment.

What you should expect in this role

• Full-time, non-exempt, 100% remote/work-from-home position for candidates residing within the United States.
• Monday through Friday schedule, 8:00 a.m.–5:00 p.m. Eastern Time.
• Frequent interaction with state agency personnel, members, providers, pharmacies, pharmacy technicians, leadership, and internal stakeholders.
• Reliable high-speed internet and a professional, distraction-free home workspace are required.
• Access to Gainwell’s competitive benefits package for eligible employees including medical, dental, vision, and 401(k) options in accordance with applicable eligibility guidelines. 

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