Supervisor, Utilization Management Technician

Jobtailor; New York (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

Jobtailor in New York seeks a Medicare Prior Authorization Supervisor to lead a team of PA technicians and collaborate with the pharmacy technician manager on staffing and workflow improvements.

The role includes coaching staff, ensuring compliance with HIPAA and SOPs, and coordinating with clinical partners to obtain necessary information for pharmacist review. Day-to-day tasks involve data review, training, and issue resolution.

Qualifications

• Minimum 1 year of Medicare experience and familiarity with policies.
• Minimum 1 year of Medicare Prior Authorization and/or Medicare appeals experience.
• Active, unrestricted National Certified Pharmacy Technician (CPhT) license.
• Proficient in Microsoft Office, especially Excel and PowerPoint.
• Strong communication and organizational skills.
• Ability to multi-task and collaborate in a team with shifting priorities.

Responsibilities

• Oversee a group of prior authorization technicians and handle select administrative PA functions.
• Collaborate with the pharmacy technician manager to analyze data and 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, addressing issues as needed.
• Investigate and resolve escalated issues from clients and providers.
• Collaborate with the utilization management manager on projects and initiatives.
• 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 required.
• Prepare prior authorization requests by validating prescriber and member information and guidelines.
• Obtain clinical information from prescribers and staff to ensure guidelines are addressed for pharmacist review.
• Identify, document, and escalate provider concerns to the internal team.
• Triage calls from members, pharmacy staff, and providers with clinical questions.
• Communicate issues and resolutions to stakeholders clearly.
• Follow SOPs and HIPAA guidelines and company policies.
• Deliver exceptional customer care in a fast-paced startup environment.
• Work in a fast-paced environment with shifting priorities and flexible schedules including weekends.
• Work flexible schedules with on-call weekend and holiday rotation.

Skills

Communication

Organizational skills

Problem solving

Multi-tasking

Team collaboration

Education

CPhT license

Job description

Responsibilities

• Oversee a group of prior authorization technicians and handle select administrative PA functions.
• Work in conjunction with the pharmacy technician manager to analyze available data and provide prior authorization staffing, workflow and system enhancement recommendations.
• Support ongoing training and coaching of utilization management pharmacy technicians.
• Participate in the goal setting process and regularly review the performance of direct reports, addressing performance and behavioral issues when needed.
• Investigate and resolve escalated issues or problems from clients and providers.
• Collaborate with the utilization management manager on other responsibilities, projects, implementations and initiatives as needed.
• 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 required.
• Prepare prior authorization requests by validating prescriber and member information, level of review, and appropriate clinical guidelines.
• Proactively obtain 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, adhere to HIPAA guidelines, and company policies.
• Ensure customer satisfaction, deliver extraordinary customer care, and resolve quality issues with genuine compassion in a fast‑paced, startup environment.
• Work in a fast‑paced environment with shifting priorities and flexible schedules that may include weekends.
• Work flexible schedules that include an on‑call weekend and holiday rotation.

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 the 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.

Certifications & Qualifications

• National Certified Pharmacy Technician (CPhT) license.