Additional Information
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 u tilization 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 u tilization 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
Capitalrx · Worldwide