Utilization Management Technician
About Judi Health 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, and 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. To learn more, visit www.judi.health. Position Responsibilities: Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. 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 Required 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 required 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, stay productive in a remote, high-volume, metric driven call center environment Ability to multi-task and collaborate in a team with shifting priorities All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit 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. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy. Apply To This Job