Judi Health - Supervisor, Utilization Management Technician
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Requirements
• At least 1 year of Medicare experience, including working knowledge of policies and guidelines • Minimum 1 year of Medicare Prior Authorization and/or Medicare appeals experience • Demonstrated ability to communicate effectively and manage team priorities • Strong organizational and problem-solving skills • Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint • Strong clinical background required • Excellent communication, writing, and organizational skills • Ability to multi-task and collaborate in a team with shifting priorities • 2+ years of leadership experience • Strong understanding of CMS regulations and payer requirements • 2+ years of PBM or Managed Care pharmacy experience
Responsibilities
• Review pharmacy claims data for proactive outreach and intervention. • Maintain quality and productivity standards for all cases triaged while minimizing compliance risk. • Work with business and clinical partners as needed. • Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. • Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. • Identify, document, and escalate provider concerns to the appropriate internal team including various members of the utilization management 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. • Ability to work in a fast-paced environment with shifting priorities, and flexible schedules that may include weekends. • Ability to work flexible schedules that includes an on-call weekend and holiday rotation.
Benefits
• Remote - $70,000 - $80,000 (final salary within this range is determined by the candidate's geographic location and applicable market tier) • 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, and skills, and location of the job. • Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. • Judi Health provides all full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents. • Judi Health provides full-time employees with the following benefits at no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program. Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment. • 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, • Capital Rx • Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and • Judi Health™, • Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. • Judi®, • 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. • $70,000—$80,000 USD • 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.
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