Location: Hybrid (Local to Denver, CO, Charlotte, NC or 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 clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
- Identify, document, and escalate provider concerns to the appropriate internal team including various members of the utilization management team.
- Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
- Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
- Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies.
- Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment.
- Ability to work in a fast-paced environment with shifting priorities, and flexible schedules that may include weekends.
- Ability to work flexible schedules that includes an on-call weekend and holiday rotation.
Required Qualifications:- At least 1 year of Medicare experience, including working knowledge of policies and guidelines
- Minimum 1 year of Medicare Prior Authorization and/or Medicare appeals experience
- Demonstrated ability to communicate effectively and manage team priorities
- Strong organizational and problem-solving skills
- Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
- Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
- Strong clinical background required
- Excellent communication, writing, and organizational skills
- Ability to multi-task and collaborate in a team with shifting priorities
Preferred Qualifications:- 2+ years of leadership experience
- Strong understanding of CMS regulations and payer requirements
- 2+ years of PBM or Managed Care pharmacy experience
New York, NY Salary Range
$78,400-$85,000 USD
Denver, CO Salary Range
$78,400-$85,000 USD
Charlotte, NC Salary Range
$78,400-$85,000 USD
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
