What We Do
LucyRx is an independent, next-generation pharmacy benefits manager (PBM) transforming how healthcare works. We're fixing what's broken in the PBM industry by putting people first and challenging outdated norms. For too long, traditional PBMs have prioritized profit over patients, and we believe that's just plain wrong.

LucyRx offers bold, innovative solutions powered by LucyIQ, our proprietary AI platform, to deliver actionable insights that lower costs, improve care, and simplify prescription management. Backed by a $500M capital investment, our high-touch service model and network of over 65,000 pharmacies are trusted by 1,200 clients and 500,000 members.

While we're new to the PBM space, LucyRx is built on decades of leadership experience and a commitment to meaningful change. We're a nimble, remote-first team with a bold mission to redefine pharmacy benefits-and we're just getting started.

What It's Like to Work at LucyRx
At LucyRx, we're a fast-moving team dedicated to making healthcare simpler, fairer, and more effective. Joining us means being part of a dynamic, mission-driven group that works collaboratively to challenge outdated industry practices and redefine what's possible in pharmacy benefits.

We value accountability, innovation, and a relentless focus on making an impact. Here, you'll find a supportive culture that encourages you to bring your whole self to work, share bold ideas, and grow alongside smart, driven colleagues who are passionate about fixing the PBM industry.

If you're ready to roll up your sleeves and make a real difference, we'd love to have you on our team.

Summary

Provides physician and member support for LucyRx while also processing prior authorization requests in a timely manner and according to high quality standards.

Role and Responsibilities

• Clinical Call center team member receives calls from Physician and member and provides the requested information or support while ensuring the privacy and security of PHI (Protected Health Information) as outlined in LucyRx's policies and procedures relating to HIPAA compliance.
• Understands the pharmacy benefit plans and accurately interprets the plan information to Physician and members.
• Technical review of authorizations (drug and utilization management) that includes reviewing authorization, chart notes, and/or relevant clinical information to render a clinical recommendation and documents all actions in ticketing system.
• Respond to prior authorization requests within compliance turnaround times and meeting quality standards regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.
• Ensure that all departmental goals (including, but not limited to turnaround, production expectations, and quality metrics) are met.
• Communicate with providers (prescriber and pharmacy) on issues related to formulary, non-formulary criteria, or respective policies and procedures.
• Generates letters to members communicating PA outcomes, or if lack of response.
• Manages the monthly medication prior authorization renewal process.
• Interface with LucyRx's adjudication system, when necessary, in regard to adjudication and medication processing issues.
• Assist Clinical Pharmacist in review of Member's medication regimen and assist in care coordination internally with Utilization Management, Behavioral Health, or Care Management departments.
• Actively participate in internal quality improvement process enhancements.
• Cross department support.
• Participate in team training and professional development of prior authorization processing, pharmacy claims, grievances, discharges, and any related pharmacy issues.
• Attendance and punctuality are essential functions for this position.
• Other duties as assigned.

Requirements

Qualifications and Education Requirements

• GED or equivalent
• Pharmacy Technician Certification Required
• 2+ years of experience in Retail Pharmacy
• Knowledge and Skills Required
• Microsoft Office experience
• Excellent organizational, written and verbal communication
• Highly motivated and good interpersonal skills, self-starter
• Excellent critical thinking skills, detail-oriented
• Ability to adapt and perform duties efficiently whenever unexpected changes arise
• Works well in a fast-paced environment
• Knowledge of pharmaceutical terminology

Preferences

• Bachelor of Arts or Science degree from accredited college
• Prior Pharmacy Benefit Management preferred
• Strong Microsoft Excel skills preferred
• Project management skills preferred

Physical Requirements

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.

This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.