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.
Minimize compliance risk; Ensure customer satisfaction; extraordinary customer care; quality resolution
Industry & Context.
problem-solving skills; Investigate/resolve escalated issues
Ability to work in a fast-paced environment, shifting priorities, flexible schedules, 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, understanding of CMS regulations, payer requirements, 2+ years of PBM or Managed Care pharmacy experience
What You'll Do.
Oversee prior authorization technicians
Analyze data for staffing recommendations
Provide workflow and system enhancement recommendations
Support training and coaching
Review performance of direct reports
Resolve escalated issues
Review pharmacy claims data
Maintain quality and productivity standards
Prepare prior authorization requests
Obtain clinical information from prescribers
Triage phone calls from members
Communicate issues and resolutions
How You'll Work.
Team & Collaboration
Work with pharmacy technician manager; Work with business and 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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