Supervisor, Utilization Management Technician

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve.

About the role

This position oversees a group of prior authorization technicians and handles select administrative prior authorization functions. You will collaborate with the pharmacy technician manager to analyze data and recommend staffing, workflow, and system enhancements. The role includes supporting training and coaching for utilization management pharmacy technicians, participating in goal setting, and reviewing performance of direct reports.

Responsibilities

• Investigate and resolve escalated issues from clients and providers.
• Work with the utilization management manager on projects, implementations, and initiatives.
• Review pharmacy claims data for proactive outreach and intervention.
• Maintain quality and productivity standards while minimizing compliance risk.
• Collaborate with business and clinical partners as needed.
• Prepare prior authorization requests by validating prescriber and member information, level of review, and clinical guidelines.
• Proactively obtain clinical information from prescribers and referral coordinators to ensure compliance with clinical guidelines.
• Identify, document, and escalate provider concerns to the appropriate internal teams.
• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client-specific clinical questions.
• Communicate issues and resolutions effectively to members, pharmacy staff, providers, and internal stakeholders.
• Follow internal Standard Operating Procedures and adhere to HIPAA guidelines and company policies.
• Ensure customer satisfaction and quality resolution in a fast-paced, startup environment.
• Work flexible schedules, including on-call weekend and holiday rotations.

Requirements

• 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.
• Proficient in Microsoft Office Suite, with emphasis on Microsoft Excel and PowerPoint.
• Strong clinical background.
• 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.

Pay

• New York, NY: $78,400 USD - $85,000 USD
• Denver, CO: $78,400 USD - $85,000 USD
• Charlotte, NC: $78,400 USD - $85,000 USD

Location: Hybrid (local to Denver, CO, Charlotte, NC, or NYC area).