Senior Utilization Management Supervisor – PA

Triwill Group; New York (NY); Hybrid; USD 78,000 - 85,000; Full time

Job summary

Judi Health is seeking a healthcare utilization management supervisor in New York to lead a team of prior authorization technicians in a hybrid setting with local ties to Denver, Charlotte or NYC. You will drive staffing, workflows, and quality in a fast-paced startup environment.

The role requires Medicare PA experience, leadership, and strong communication. You will collaborate with clinical partners, ensure HIPAA compliance, and contribute to ongoing process improvements and staff development.

Qualifications

• At least 1 year of Medicare experience.
• 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 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.

Responsibilities

• Oversee a group of prior authorization technicians and expanded responsibility for select administrative PA functions.
• Analyze data with the pharmacy technician manager to provide staffing, workflow and system enhancement recommendations.
• Support ongoing training and coaching of utilization management pharmacy technicians.
• Participate in goal setting and regularly review performance of direct reports.
• Investigate/resolve escalated issues from clients and providers.
• Work with utilization management manager on projects, implementations and initiatives as needed.
• Review pharmacy claims data for proactive outreach and intervention.
• Maintain quality and productivity standards for all cases while minimizing compliance risk.
• Collaborate with business and clinical partners as needed.
• Prepare prior authorization requests by validating prescriber and member information and guidelines.
• Proactively obtain clinical information to ensure guidelines are addressed for pharmacist review.
• Identify and elevate provider concerns to internal teams.
• Triage calls from members, pharmacy staff, and providers and communicate resolutions.
• Follow SOPs and HIPAA guidelines.

Skills

Medicare experience

Prior Authorization

Leadership

Communication

Organizational skills

Education

CPhT license (Active)

Tools

Microsoft Office Suite

Excel

PowerPoint

Job description

Judi Health is seeking a healthcare utilization management supervisor in New York to lead a team of prior authorization technicians in a hybrid setting with local ties to Denver, Charlotte or NYC. You will drive staffing, workflows, and quality in a fast-paced startup environment.

The role requires Medicare PA experience, leadership, and strong communication. You will collaborate with clinical partners, ensure HIPAA compliance, and contribute to ongoing process improvements and staff development.