[Hiring] Utilization Management Technician @Judi Health

Role Description

• Prepare prior authorization requests by validating prescriber and member information, level of review, and appropriate clinical guidelines.
• Make outbound calls to providers to obtain additional clinical information for pharmacist review.
• Proactively obtain clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed.
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Identify, document, and escalate provider concerns to the appropriate internal team, including various members of the Prior Authorization Team.
• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client-specific clinical questions.
• Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies.
• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast-paced, startup environment.

Qualifications

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting.
• Experience handling prior authorization requests/understanding of prior authorization requirements.
• National Certified Pharmacy Technician (CPhT) license, required.
• High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred.
• Excellent communication, writing, and organizational skills.
• Ability to work independently with minimal supervision in a remote, high-volume, metric-driven call center environment.
• Ability to multi-task and collaborate in a team with shifting priorities.

Requirements

• This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
• Remote, US Salary Range: $50,000 — $60,000 USD.

Benefits

• Equal employment opportunities to all employees and applicants for employment.
• Prohibition of discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.