Role Description The Central Prior Authorization Pharmacy Technician will serve as the primary coordinator for specialty medication prior authorizations (PAs), ensuring timely processing and approval of specialty drug therapies. This role will work closely with prescribers, patients, insurance providers, specialty pharmacies, and internal pharmacy teams to facilitate medication access, obtain required documentation, track authorization statuses, and support the reimbursement process. This position requires strong organizational skills, attention to detail, and knowledge of specialty pharmacy and insurance workflows. This position can be remote, home-based requiring reliable internet access and a private workspace for confidential patient interactions. Must adhere to all company policies, procedures, confidentiality standards, and security protocols applicable to remote employees. Duties and Responsibilities - Manage and process prior authorization requests for specialty medications. - Communicate with provider offices, patients, payers, and specialty pharmacies to obtain clinical documentation and authorization approvals. - Submit, monitor, and track PA requests through payer portals, fax, phone, and electronic systems. - Follow up on pending PAs, appeals, renewals, and denials to ensure timely patient access. - Verify patient insurance coverage, benefits, and specialty pharmacy requirements. - Input all necessary data into the pharmacy management system to track and maintain up-to-date project information. - Receive, analyze, gather, and organize data from multiple sources. - Accurately enter required data into one or more databases, documents, or spreadsheets. - Work closely with different functional departments including but not limited to pharmacy operations, sales, and data team. - Support all existing data projects. - Use pharmacy system to obtain patient and drug information and process prescriptions. - Manage prescription refills for integrated offices. - Apply manufacturer copay cards if applicable. Qualifications - Pharmacy Technician Experience. - Experience with specialty medications and prior authorization processes preferred. - Knowledge of commercial, Medicare, and Medicaid insurance plans. - Familiarity with specialty pharmacy workflows and reimbursement procedures. - Familiar with the prescription adjudication process. - Ability to learn pharmacy management systems to extrapolate pertinent data. - Ability to communicate effectively within various levels of the organization. Requirements - Ability to read, comprehend, and write correspondence. - Ability to effectively present information in one-on-one and small group situations to all employees of the organization. - Ability to comprehend and apply principles of basic math. - Ability to apply common sense understanding. - Strong analytical and problem-solving skills. - Excellent interpersonal, negotiation, and conflict resolution skills. - Proficient in Word and Excel or related software. - Comfortable using RingCentral and experience with patient outreach. - Experience using payer portals such as CoverMyMeds or similar authorization platforms preferred. Knowledge, Skills, and Other Abilities - Time management - Oral and written communication skills - Professionalism - Organization skills - Customer Service - Prioritizing skills - Detail-oriented - Multi-task abilities - Goal-oriented - Dependable - Confidentiality - Self-motivated - Ability to work well with various departments and within a team. - Participate in continuous quality improvement activities Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to walk, sit, and use hands. The employee is occasionally required to stand.

Role Description As a Senior Director within our network pharmacy contracting team, you'll guide the development and support of provider networks as well as unit cost management activities through financial and network pricing modeling, analysis, and reporting. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. - Establishes and maintains solid business relationships with provider pharmacies in support of clients, ensuring the network composition includes an appropriate distribution of provider specialties, competitive rates and access to limited and exclusive drugs. - Develops the pharmacy networks yielding a geographically competitive, broad and focused access, that achieves objectives for cost performance and trend management producing an affordable and predictable product for customers and business partners. - Demonstrate understanding of complex contract language in order to assess financial, non-financial and operational impact and legal implications of requested contract changes. - Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess). - Present and discuss industry and market trends with internal and/or external groups (e.g., customer groups; brokers; professional associations; providers) to facilitate market strategy development and implementation. - Have a solid understanding of provider termination processes and implications. - Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information. - Evaluates and negotiates contracts in compliance with client contracts, reimbursement structures, and other key process control. - Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship. - Provides leadership to and is accountable for the performance and results through multiple layers of management and senior level leadership. - Pharmacy network contract negotiation and product support and development of geographically competitive, broad and focused access networks. - Provide leadership to a high performing team to deliver their life’s best work. Qualifications - Proven extensive experience developing pricing & utilizing financial modeling in making rate decisions. - Proven experience interacting with executive leadership. - Proven experience leading a team of direct reports. - Proven experience understanding financials and explaining details. Requirements - Proven extensive experience in a healthcare contracting related role (Medical/Pharmacy/Pharmaceuticals, etc.) overseeing complex relationships with accountability for business results. - Proven experience with large scale negotiations (min 2B/contract or greater). - Proven experience with client presentations (verbal and PowerPoint creation). - Proven sales experience. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - The salary for this role will range from $134,600 - $230,800 annually based on full-time employment.

• Engage in multiple complex client projects simultaneously while ensuring all role deliverables are accomplished on time and accurately documented. • Execute a meticulous review of incumbent plan documents, claim file analysis, and review of other critical benefit design set-up information to inform plan specifications and recommendations to clients and brokers, taking into consideration the nuances of RxBenefits programs and those of the partnering PBM. • Operate as the pharmacy benefit expert for new client implementations, TPA changes, PBM to PBM transitions, and end-to-end plan design audits and other projects, as requested by leadership. • Actively communicate with and relays benefits design set-up information to internal stakeholders, including the Project Lead, Account Manager, Business Development Executive, Clinical and Benefit Configuration Specialist. • Accountable for ensuring client’s benefit intent and benefit design are aligned, accurately documented, and communicated to all necessary parties. • Attend and participate in client and vendor calls. • Responsible for consultative and dynamic conversations with complex clients and brokers regarding the benefit set-up and program/product selection. • Serves as a benefit expert and resource to support department and corporate initiatives. • Proficiently know product, program, benefit design, services, and market conditions to make informed decisions and recommendations to clients and brokers. • Maintain updated client-facing project plan. • Resolve escalated issues and conflicts that arise during project execution, ensuring minimal disruption to project timelines. • Proactively review existing project workflows/deliverables and communicate process improvement opportunities to leadership. • Lead complex process improvement initiative projects during non-peak months, highlighting milestones and strategic outcomes and provide readouts. • Promote best practices and actively contribute to the betterment of the team and organization. • Demonstrate a wide degree of creativity and latitude, with minimal oversight. • Act as Implementation expert in finalist meetings with potential brokers and clients. • Act as a SME resource to help Implementation Teams prepare for Intro and PDX calls. • Act as a Change Champion and exude positivity towards change management to foster acceptance amongst the team.

• Participate in multiple client projects simultaneously while ensuring all role deliverables are accomplished on time and accurately documented. • Complete a second level review of the data gathering process for new client implementations which includes: meticulous review of incumbent plan documents, claim file analysis, and review of other critical benefit design set-up information. • Serves as the pharmacy benefit expert on the following projects: new client implementations, medical vendor changes, eligibility changes, TPA changes, PBM to PBM transitions, and other complex clients requests. • Actively communicates with and relays benefits design set-up information to internal stakeholders including the Project Lead and Benefit Configuration Specialist. • Ensure the client’s benefit intent and benefit design are aligned, accurately documented and communicated. • Attend and participate in client and vendor calls. • Lead consultative and dynamic conversations with clients and EBCs regarding the benefit set-up and program/product selection. • Proactively review existing project workflows/deliverables and communicate process improvement opportunities. • Serves as a benefit expert and resource to support department and corporate initiatives. • Actively seeks to improve product, program, and benefit design knowledge as well as staying up to date on new products and market conditions. • Track and log defined tasks and deliverables within Clarizen. • Appropriately support the risk management team and the Client Command Center process. • Meet KPI goals as defined by Operations leadership and department. • Other duties as assigned.