Utilization Manager Appeals Technician
New
J
Judi HealthHealth Technology
Remote, 12pm-9pm ESTTemporaryMiddle
Salary60,000 - 65,000 USD per year
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Job Details
- Experience
- 1+ years
- Required Skills
- HIPAA
Requirements
- 1+ years experience working as a certified pharmacy technician in a managed care or PBM setting.
- Active, unrestricted certified pharmacist technician license.
- Excellent organization details and strong detail orientation.
- Strong oral and written communication skills.
- Ability to work independently with minimal supervision.
- Ability to stay productive in a remote, high-volume, metric driven environment.
- Ability to work 12pm-9pm EST hours.
Responsibilities
- Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements.
- Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities.
- Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies.
- Review all cases received, to verify if case meets qualifications for appeal review.
- Performs triple check to ensure quality reviews and handling in accordance with policies and procedures.
- Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations.
- Communicate effectively with appeal pharmacists regarding internal and external appeals.
- Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call.
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