Clinical Pharmacy Technician Sr - Medi-Cal Rx

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Clinical Pharmacy Technician Sr - Medi-Cal Rx Job Description The Senior Clinical Pharmacy Technician – Medi-Cal independently manages prior authorization requests, eligibility, pharmacy benefits, and claims using established clinical criteria. This role serves as a technical resource to team members, supports resolution of non-routine cases, and identifies opportunities to improve workflow efficiency. Responsibilities Independently review, research, and resolve prior authorization requests by applying clinical criteria, established guidelines, and professional judgment within defined protocols Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring clarity and accuracy in non-routine scenarios Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations, resolving moderately complex issues and determining appropriate next steps Escalate clinically complex or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support timely resolution Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks Initiates, prioritize, and manage cases by accurately gathering and entering member and provider information Identify trends, root causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, quality, and consistency Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities Other duties as assigned Minimum Qualifications High school diploma from a