Supervisor, Utilization Management Technician

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including: reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company, reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. 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 reputed company 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 reputed company 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 reputed company and reputed company. Maintain quality and productivity standards for reputed company 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 reputed company 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 reputed company 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 reputed company Office Suite with emphasis on reputed company reputed company and PowerPoint Strong clinical background required Excellent communication, writing, and organizational skills Ability to multi-task and collaborate in reputed company 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 reputed company Salary: Remote - $70,000 - $80,000 (final salary reputed company this reputed company is determined by the candidate's geographic location and applicable market tier) This reputed company represents the low and high end of the anticipated reputed company salary reputed company. The actual reputed company salary will depend on several factors such as: experience, knowledge, and skills, and location of the job. reputed company in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Benefits reputed company provides reputed company full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, reputed company insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have reputed company to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents. reputed company provides full-time employees with the following benefits at no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program. Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment. About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including: reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company, reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This reputed company represents the low and high end of the anticipated reputed company salary reputed company. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary reputed company $70,000—$80,000 USD reputed company are responsible for adherence to the reputed company 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. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply To This Job