Utilization Management Technician (temp-to-hire)

Judi Health; Deutschland; Vor Ort; EUR 43.786 - 52.543; Vollzeit

Zusammenfassung

Judi Health is seeking a Pharmacy Technician to handle prior authorizations in a remote, fast-paced startup environment. The role requires CPhT certification, PBM experience, and strong communication skills.

You will review pharmacy claims data, obtain necessary clinical information, and collaborate with the Prior Authorization Team to ensure timely determinations. The position emphasizes independence, high-volume workload management, and adherence to HIPAA and company policies while delivering

Qualifikationen

• 2+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy setting.
• Experience handling prior authorization requests.
• National Certified Pharmacy Technician (CPhT) license.
• High school diploma or equivalent; Associate’s or bachelor’s degree preferred.
• Excellent written and verbal communication and organizational skills.
• Ability to work independently in a remote, high-volume call center environment.
• Ability to multitask and collaborate in a team with shifting priorities.

Aufgaben

• Prepare prior authorization requests by validating information and guidelines.
• Make outbound calls to providers to obtain clinical information for determinations.
• Obtain clinical information from prescribers and staff to support reviews.
• Review and analyze pharmacy claims data for outreach and intervention.
• Identify and escalate provider concerns to the Prior Authorization Team.
• Triage calls by asking drug- and client-specific clinical questions.
• Communicate issues and resolutions to members, staff, and stakeholders.
• Follow SOPs and HIPAA guidelines.
• Ensure customer satisfaction and high-quality service in a fast-paced startup.

Kenntnisse

Pharmacy Technician Experience

Prior Authorization

CPhT Licensed

Communication Skills

Remote Work

Ausbildung

High School Diploma

Associate/Bachelor preferred

Jobbeschreibung

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 elevate 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

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

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.