Utilization Management Technician (temp-to-hire)

About the company

The company is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. The company replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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, the company helps clients achieve unprecedented operational efficiency and service levels.

At the company, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit [link for members] .

Position Responsibilities

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines

• Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review

• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.

• Review and analyze pharmacy claims data for proactive outreach and intervention.

• Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization 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

Required Qualifications

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting

• Experience handling prior authorization requests/understanding of prior authorization requirements required

• National Certified Pharmacy Technician (CPhT) license, required

• High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred

• Excellent communication, writing, and organizational skills

• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment

• Ability to multi-task and collaborate in a team with shifting priorities

• Availability to work after hours, weekends, and holidays on a rotating schedule

• Able to work either 12p-9pm or 2p-11pm ET shift

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary Range

$50,000 — $60,000 USD

All employees are responsible for adherence to the 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.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, 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 the company. More details about the company's privacy practices can be found at   [link for members] .