Job Overview
Location
Remote
Job Type
Full-time
Category
Operations
Date Posted
February 24, 2026
Full Job Description
đź“‹ Description
- • Join Rightway Healthcare, Inc. as a Utilization Management Pharmacy Technician (CPhT) and become an integral part of our innovative RightwayRx Operations team. This pivotal role is designed for individuals passionate about transforming healthcare by improving the affordability and accessibility of medications for clients and their employees. You will play a key role in executing our unique Pharmacy Benefit Management (PBM) strategy, which is built on the core principles of fairness, transparency, supply chain optimization, support for the physician-patient relationship, and consumer empowerment through expert navigation.
- • In this remote position, you will be instrumental in facilitating the utilization management (UM) process across all lines of business. Your primary responsibilities will involve managing coverage requests, accurately entering authorizations into our claims platform, and ensuring seamless communication with both members and healthcare providers. This requires a meticulous approach to documentation and a commitment to clear, timely information exchange.
- • A significant aspect of your role will be providing dedicated support to members enrolled in our specialty management programs. This includes proactively coordinating prior authorizations with the UM team, ensuring the efficient fulfillment of prescriptions by our specialty pharmacy partners, assisting members with enrollment in vital patient assistance programs, and addressing any billing inquiries they may have. Your efforts here directly impact a member's ability to access critical medications.
- • You will collaborate closely with fellow Pharmacy Technicians, Pharmacists, and Medical Directors, contributing to the overall success of our UM activities. This collaborative environment fosters learning and ensures that all cases are handled with the highest level of expertise and adherence to best practices.
- • A key responsibility involves making outbound calls to provider offices to gather essential clinical information that may be missing from submitted UM cases. This proactive outreach is crucial for the timely and accurate review of requests, ensuring that patient care is not delayed.
- • You will be responsible for ensuring that all UM cases are reviewed in strict accordance with State and Federal guidelines, with a particular focus on meeting all turnaround time requirements. This adherence to regulatory standards is paramount to our operations and member trust.
- • Your involvement in quality review and inter-rater reliability processes will be vital in maintaining the high standards of our UM operations. By participating in these reviews, you help ensure consistency and accuracy across the team.
- • You will also serve as a point of contact for our provider call center, responding to prescriber inquiries regarding the status of UM requests. Your ability to provide clear, concise, and helpful information will be highly valued.
- • Maintaining compliance with all regulatory and privacy standards, including HIPAA, is a non-negotiable aspect of this role. You will ensure that all actions and documentation meet these critical requirements, safeguarding sensitive patient information.
- • This role offers a unique opportunity to be at the forefront of a new PBM model, contributing to a company that is dedicated to harmonizing healthcare. You will be part of a mission-driven organization that values innovation, empathy, and a relentless pursuit of better healthcare outcomes. Your work will directly contribute to making healthcare more affordable and understandable for countless individuals and families.
- • We are looking for individuals who possess a keen eye for detail, strong critical thinking skills, and a deeply empathetic nature. The ability to thoroughly investigate issues to identify root causes and implement effective resolutions is essential. A genuine desire to enhance a patient's healthcare experience and deliver concierge-level service will set you apart. If you are motivated by making a tangible difference in people's lives and thrive in a dynamic, remote work environment, this role is an excellent fit for you.
🎯 Requirements
- • Active Certified Pharmacy Technician (CPhT) certification.
- • 1-2 years of experience in a pharmacy technician role within a PBM, health plan pharmacy department, or similar managed care setting, OR 1-2 years of experience working in a mail-order or specialty pharmacy.
- • Associate's or Bachelor's degree preferred.
- • Detail-oriented, critical thinker, empathetic, with the ability to dig deep into understanding an issue to get to the true root cause and resolution.
🏖️ Benefits
- • Competitive hourly wage of $21-22/hr.
- • Fully remote work environment, offering flexibility and work-life balance.
- • Opportunity to be part of a mission-driven company transforming the healthcare industry.
- • Comprehensive benefits package (details typically provided during the interview process, but often include health, dental, vision insurance, paid time off, etc.).
Skills & Technologies
Remote
$21-22/hr
Degree Required
About Rightway Healthcare, Inc.
Rightway Healthcare provides a healthcare navigation and pharmacy benefit platform that combines clinical guidance with transparent pricing to lower employer healthcare costs. Its mobile and web tools connect members to dedicated clinicians and pharmacists who steer them to high-value providers, optimize prescriptions, and resolve claims issues. The company integrates with existing health plans, replacing traditional PBMs and navigation vendors. Founded in 2017, Rightway serves self-insured employers and health plans across the United States, aiming to improve outcomes and reduce spending through data-driven, human-led care navigation.
Get more remote jobs like this
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
Buenos Aires (Alem)
Full-time
Expires Jun 6, 2026
Onsite
15 days ago
