Utilization Management Team Lead — Prior Authorization

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

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.