[Hiring] Utilization Manager Appeals Technician @Judi Health

Role Description

Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity. Work with appeals team for multiple lines of business such as Commercial, Exchange and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors.

• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements.
• Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies.
• Review all cases received, to verify if case meets qualifications for appeal review.
• Perform triple check to ensure quality reviews and handling in accordance with policies and procedures.
• Update case types, send appeal acknowledgements, and submit case information to independent review organizations.
• Communicate effectively with appeal pharmacists regarding internal and external appeals.
• Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call.
• Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers.
• Perform all other related duties as assigned.

Qualifications

• 1 + years’ experience working as a certified pharmacy technician in a managed care or PBM setting required.
• Active, unrestricted certified pharmacist technician license required.
• Excellent organization details and strong detail orientation.
• Strong oral and written communication skills.
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities.
• Ability to work 12pm-9pm EST hours.

Preferred Qualifications

• Experience working with commercial and medicare appeals preferred.

Salary Range

• Remote, US Salary Range: $60,000 — $65,000 USD
• New York, NY Salary Range: $78,800 — $98,500 USD
• Denver, CO Salary Range: $72,000 — $90,000 USD

Company Description

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers.
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans.
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.