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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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, setting goals, reviewing performance, and addressing issues for direct reports. You will also investigate and resolve escalated issues from clients and providers, work on special projects, and ensure compliance with quality and productivity standards.

Responsibilities

• Oversee a team of prior authorization technicians and manage select administrative prior authorization functions.
• Analyze data and provide recommendations for prior authorization staffing, workflow, and system enhancements in collaboration with the pharmacy technician manager.
• Support ongoing training and coaching of utilization management pharmacy technicians.
• Participate in goal setting and regularly review performance of direct reports, addressing performance and behavioral issues as needed.
• Investigate and resolve escalated issues or problems from clients and providers.
• Work with the utilization management manager on other responsibilities, projects, implementations, and initiatives.
• 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 by validating prescriber and member information, level of review, and appropriate clinical guidelines.
• Proactively obtain 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.
• Work flexible schedules that may include weekends and an on-call weekend and holiday rotation.

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 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.

Location

Hybrid (Local to Denver, CO, Charlotte, NC, or NYC area).

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