• Performs telephonic comprehensive medication reviews • Updates patient profiles based on information gathered during the review • Reviews any Drug Therapy Problems to optimize patient’s drug therapy and minimize the potential for adverse drug reactions • Works with multidisciplinary team to enhance and develop our MedPro software. • Completes at least (2) two CMR’s per hour • Assists Clinical team in meeting proficiency and quality goals • Utilizes client formulary information and member specific benefits to guide appropriate medication recommendations • Maintains current on emerging trends that will educate clinical team, physicians and other prescribers

Role Description This position is available to work from home from within the Sutter Health Northern California footprint. Responsible for performing the appropriate processes to verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed for said order. If needed, obtains authorization and documents in the patient electronic medical record. Facilitates responses to patient inquiries regarding authorizations within turnaround standards. Qualifications - HS Diploma or GED - 1 year recent relevant experience Requirements - Medical terminology knowledge - Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge - Knowledge of medical terminology/anatomy - Ability to exercise discretion and make independent judgments, seeking review when decisions represent significant departure from established guidelines - Knowledge of Microsoft Office programs including Excel, Word or similar programs - Ability to maintain composure during challenging interpersonal interactions - Active listening skills; including interpersonal skills and telephone communication - Organizational skills with attention to detail and follow-up Benefits - Eligible positions include a comprehensive benefits package Company Description Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $27.50 to $34.37 / hour. The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program.

Role Description The Pharmacy Technician I supports the organization’s mission and purpose by providing front-line customer support for a diverse portfolio of customers. The incumbent will handle inbound telephone inquiries from Members, pharmacies, and Prescribers in our National Customer Care Center, and will consistently meet established productivity, schedule adherence, and quality standards. Work Arrangement: Remote Responsibilities - Provide real-time support to pharmacies with point-of-service inquiries - Educate prescribers on formulary and prior authorization processes - Enter customer data and other relevant information into our documentation tool - Assist members with pharmacy benefit inquiries - Adhere to standard operating procedures to ensure contact handling accuracy and operational effectiveness - Effectively communicate issues and resolutions to customers and appropriate internal staff Qualifications - Bachelor's degree or equivalent experience required - Minimum three (3) years of current/recent PBM and/or current/recent pharmacy experience required Requirements - Active/current National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one within the first six (6) months of employment is required Benefits - Flexible work solutions include remote options - Competitive pay - Paid Time Off (PTO), including holidays and volunteer events - Health insurance coverage for you and your dependents on Day 1 - 401(k) - Tuition reimbursement - And more

• Responsible for the design, configuration, and quality assurance of prior authorization (PA) criteria • Ensures clinical intent is accurately translated into compliant, efficient system logic through structured QA/QC and validation processes • Collaborates with internal teams and external clients to support delegated PA services and drive system optimization • Build decision trees and question sets from PA criteria for prior authorization review • Perform comprehensive quality control (QC) review of decision trees, questionnaires, and authorization logic to ensure alignment with clinical intent, regulatory requirements, and business rules • Conduct quality assurance (QA) validation of configured criteria and decision paths • Ensure PA questionnaires are configured with the appropriate authorization parameters for approval • Collaborate with external clients for delegated clinical PA systems services • Manage setup, contracting, and relationships with prior authorization external vendors • Mapping of prior authorization member and prescriber letter templates in the prior authorization system • Validate that denial rationales, approval language, and conditional messaging accurately reflect clinical criteria and system outputs • Creation and maintenance of Commercial and Government denial verbiage templates • Develops and maintains policies and procedures for creation and maintenance of clinical criteria questions and letter templates • Establish and maintain QA/QC standards, documentation, and audit processes for decision trees, criteria configurations, and letter templates • Identify PA reporting needs and collaborating with appropriate stakeholders to develop reports • Respond to requests for clinical criteria from members and prescribers • Attend formulary meetings and presentations