Utilization Management Technician
New
J
Judi HealthHealth Technology
Remote, US Salary RangeContractMiddle
Salary50,000 - 60,000 USD per year
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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.
- National Certified Pharmacy Technician (CPhT) license.
- High school diploma or equivalent.
- Excellent communication, writing, and organizational skills.
- Ability to work independently with minimal supervision in a remote, metric-driven 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.
Responsibilities
- Prepare prior authorization requests by validating prescriber and member information and clinical guidelines.
- Make outbound calls to providers to obtain 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 Prior Authorization Team.
- Triage phone calls from members, pharmacy personnel, and providers.
- Communicate issues and resolutions to members, pharmacy staff, and stakeholders.
- Follow internal Standard Operating Procedures and adhere to HIPAA guidelines.
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