Utilization Management Lead — Prior Authorization

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

Job summary

Judi Health, a health technology company delivering Unified Claims Processing™ for benefit administration, seeks experienced leaders for a Medicare-focused Prior Authorization role in the New York area. You will supervise PA technicians, coordinate with the utilization management team, and ensure compliant, high-quality staffing and processes.

The role requires Medicare expertise, strong communication, and the ability to handle multiple priorities in a fast-paced startup environment.

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

Responsibilities

• Oversee a group of prior authorization technicians and expanded administrative PA functions.
• Work 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.
• Investigate/resolve escalated issues from clients and providers.
• Review pharmacy claims data for proactive outreach and intervention.
• Maintain quality and productivity standards for all cases triaged while minimizing compliance risk.
• Communicate effectively with members, pharmacy staff, providers, and internal stakeholders.

Skills

Medicare exp

Prior Authorization

Communication

Organization

Clinical background

Tools

Microsoft Excel

PowerPoint

Job description

Judi Health, a health technology company delivering Unified Claims Processing™ for benefit administration, seeks experienced leaders for a Medicare-focused Prior Authorization role in the New York area. You will supervise PA technicians, coordinate with the utilization management team, and ensure compliant, high-quality staffing and processes.

The role requires Medicare expertise, strong communication, and the ability to handle multiple priorities in a fast-paced startup environment.