Utilization Management Technician
J
Judi HealthHealth Technology
RemoteContractMiddle
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- 2+ years
- Required Skills
- HIPAA
Requirements
- 2+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy setting.
- Experience handling prior authorization requests and understanding of requirements.
- Current National Certified Pharmacy Technician (CPhT) license.
- High school diploma or equivalent; Associate’s or bachelor’s degree preferred.
- Excellent communication, writing, and organizational skills.
- Ability to work independently with minimal supervision.
- Ability to stay productive in a remote, high-volume, metric-driven call center environment.
- Ability to multi-task and collaborate effectively in a team with shifting priorities.
Responsibilities
- Prepare prior authorization requests by validating prescriber and member information and checking clinical guidelines.
- Make outbound calls to providers to obtain additional clinical information for pharmacist review.
- Proactively obtain clinical information from prescribers and referral coordinators.
- Review and analyze pharmacy claims data for proactive outreach and intervention.
- Identify, document, and escalate provider concerns to the appropriate internal team.
- Triage phone calls from members, pharmacy personnel, and providers using drug and client-specific clinical questions.
- Communicate issues and resolutions to members, pharmacy staff, and stakeholders.
- Follow internal Standard Operating Procedures and adhere to HIPAA guidelines.
View Full Description & ApplyYou'll be redirected to the employer's site
