Judi Health
health technology
Supervisor,UtilizationManagementTechnician
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“Supervisor, Utilization Management Technician at Judi Health. Skills: Utilization Management, Prior Authorization, Team Supervision. Oversee prior authorization technicians. Analyze data for staffing recommendations”
What You'll Achieve.
Maintain quality and productivity standards; Minimize compliance risk; Ensure customer satisfaction; extraordinary customer care; quality resolution
Industry & Context.
problem-solving skills; Investigate issues; Resolve problems
flexible schedules that may include weekends, on-call weekend and holiday rotation
What They're Looking For.
Must Have
1 year of Medicare experience, Medicare Prior Authorization and/or Medicare appeals experience, National Certified Pharmacy Technician (CPhT) license, Proficient in Microsoft Office Suite, Microsoft Excel, Microsoft PowerPoint, clinical background
Nice to Have
2+ years of leadership experience, 2+ years of PBM or Managed Care pharmacy experience
What You'll Do.
Oversee prior authorization technicians
Analyze data for staffing recommendations
Provide workflow enhancement recommendations
Provide system enhancement recommendations
Support training of technicians
Coach utilization management technicians
Review performance of direct reports
Resolve escalated issues from clients
Resolve escalated issues from providers
Review pharmacy claims data
Maintain quality standards for cases
Maintain productivity standards for cases
Minimize compliance risk
Prepare prior authorization requests
Validate prescriber information
Validate member information
Validate level of review
Validate clinical guidelines
Obtain clinical information from prescribers
Obtain clinical information from referral coordinators
Document provider concerns
Escalate provider concerns
Triage phone calls from members
Triage phone calls from pharmacy personnel
Triage phone calls from providers
Ask drug specific clinical questions
Ask client specific clinical questions
Communicate issues to members
Communicate issues to pharmacy staff
Communicate issues to providers
Communicate issues to internal stakeholders
Communicate resolutions to members
Communicate resolutions to pharmacy staff
Communicate resolutions to providers
Communicate resolutions to internal stakeholders
Follow internal Standard Operating Procedures
Adhere to HIPAA guidelines
Adhere to Company policies
Ensure customer satisfaction
Provide extraordinary customer care
Provide quality resolution
Work in a fast-paced environment
Work with shifting priorities
Work flexible schedules
How You'll Work.
Team & Collaboration
Work with pharmacy technician manager; Work with business partners; Work with clinical partners; Collaborate in a team
Communication Scope
communicate effectively; Excellent communication; writing skills
Full Job Description
About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U. S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health. Location: Remote (For Non-Local) or Hybrid (Local to NYC area) Position Responsibilities: Responsible for overseeing a group of prior authorization technicians and expanded responsibility for select administrative PA functions. Work in conjunction with the pharmacy technician manager in analyzing available data and provide prior authorization staffing, workflow and system enhancement recommendations. Support on-going training and coaching of utilization management pharmacy technicians. Participate in the goal setting process and regularly review performance of direct reports, addressing performance and behavioral issues when needed. Investigate/resolve escalated issues or problems from clients and providers. Works with utilization management manager on other responsibilities, projects, implementations and initiatives as needed. 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 needed. Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. Proactively obtains cl
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