Supervisor, Utilization Management Technician

Judi Health; New York (NY); Hybrid; USD 78,000 - 85,000; Full time

Job summary

Judi Health in New York, NY is seeking an experienced Prior Authorization Supervisor to oversee a team of PA technicians and collaborate with the utilization management group to optimize workflows and ensure compliant, high-quality service.

The role requires Medicare experience, strong communication and leadership skills, and the ability to thrive in a fast-paced startup environment. Hybrid work is available with responsibilities across multiple locations.

Qualifications

• 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.
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint.
• Strong clinical background required.

Responsibilities

• Oversee a group of prior authorization technicians and expanded responsibility for select administrative PA functions.
• Analyze data with the pharmacy technician manager and provide staffing, workflow and system enhancement recommendations.
• Support training and coaching of utilization management pharmacy technicians.
• Review performance of direct reports and address issues as needed.
• Investigate/resolve escalated issues from clients and providers.
• Collaborate with utilization management manager on projects and initiatives as needed.
• Review pharmacy claims data for proactive outreach and intervention.
• Maintain quality and productivity standards while minimizing compliance risk.
• Prepare prior authorization requests validating prescriber and member information and guidelines.
• Obtain clinical information from prescribers and staff to ensure guidelines are addressed for review.
• Identify and escalate provider concerns to the internal teams.
• Triage calls from members, pharmacy staff, and providers with clinical questions.
• Communicate issues and resolutions to stakeholders.

Skills

Medicare experience

Prior Authorization

Leadership

Communication

Excel

PowerPoint

Clinical background

Tools

Microsoft Excel

Microsoft PowerPoint

Job description

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health .

Location: Hybrid (Local to Denver, CO, Charlotte, NC or NYC area)

Position Responsibilities

• Responsible for overseeing a group of prior authorization technicians and expanded responsibility forselectadministrative PA functions.
• Work in conjunction with the pharmacy technician manager in analyzing available data and provide prior authorization staffing, workflow and system enhancement recommendations.
• Support on-going training and coaching of u tilization management pharmacy technicians.
• Participate in the goal setting process and regularly review performance of direct reports, addressing performance and behavioral issues when needed.
• Investigate/resolve escalated issues or problems from clients and providers.
• Works with utilization management manager on other responsibilities, projects,implementationsand 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 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, andappropriate staffto ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Identify, document, and elevate provider concerns to the appropriate internal team including various members of the u tilization 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.
• Abilityto work flexible schedules that includes an on-call weekend and holiday rotation.

Required Qualifications

• 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
• 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

Preferred Qualifications

• 2+ years of leadership experience
• Strong understanding of CMS regulations and payer requirements
• 2+ years of PBM or Managed Care pharmacy experience

New York, NY Salary Range

$78,400 - $85,000 USD

Denver, CO Salary Range

$78,400 - $85,000 USD

Charlotte, NC Salary Range

$78,400 - $85,000 USD

All employees are responsible for adherence to the Judi Health 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.

We 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 athttps://www.judi.health/legal/privacy-policy .

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Judi Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Voluntary Self-Identification of Disability

Form CC-305

Page 1 of 1

OMB Control Number 1250-0005

Expires 07/31/2029

Why are you being asked to complete this form? We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .

How do you know if you have a disability? A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

• Alcohol or other substance use disorder (not currently using drugs illegally)
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or serious difficulty hearing
• Diabetes
• Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
• Intellectual or developmental disability
• Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
• Missing limbs or partially missing limbsMobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
• Short stature (dwarfism)
• Traumatic brain injury

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.