Utilization Management Technician (temp-to-hire)

Capital Rx Inc.; New York (NY); Remote; USD 50,000 - 60,000; Full time

Job summary

Judi Health is seeking a Pharmacy Technician to support prior authorization requests and pharmacist reviews in a remote US-based role. You will validate prescriber and member information, guide reviews with clinical guidelines, and liaise with providers to gather necessary data.

This position emphasizes accurate claims analysis, proactive outreach, HIPAA compliance, and high-volume, metric-driven performance.

Qualifications

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting.
• Experience handling prior authorization requests/understanding of prior authorization requirements.
• National Certified Pharmacy Technician (CPhT) license is required.
• High school diploma or the equivalent; Associate's or bachelor's degree is preferred.

Responsibilities

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
• Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review.
• Proactively obtain clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Identify, document, and elevate provider concerns to the appropriate internal team including various members of the Prior Authorization 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

Skills

Pharmacy Technician

Prior Authorization

Communication

Remote Work

Multitasking

Education

CPhT License

HS Diploma

AA/BA Preferred

Job description

About Judi Health

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.

Position Responsibilities

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines
• Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review
• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Identify, document, and elevate provider concerns to the appropriate internal team including various members of the Prior Authorization 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

Required Qualifications

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
• Experience handling prior authorization requests/understanding of prior authorization requirements required
• National Certified Pharmacy Technician (CPhT) license, required
• High school diploma or the equivalent; Associate's or bachelor's degree is preferred
• Excellent communication, writing, and organizational skills
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
• Ability to multi-task and collaborate in a team with shifting priorities
• Availability to work after hours, weekends, and holidays on a rotating schedule

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary Range$50,000—$60,000 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.