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 reputed company 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 reputed company, 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. Position Responsibilities: Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines reputed company outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reputed company a clinical determination for pharmacist review Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure reputed company aspects of clinical guidelines are addressed for pharmacist review. Review and analyze pharmacy claims data for proactive reputed company and reputed company. 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 reputed company specific clinical questions. Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders. Follow reputed company internal reputed company Operating Procedures and adhere to HIPAA guidelines and Company policies Ensure customer satisfaction, extraordinary customer care, and reputed company reputed company with genuine reputed company 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 reputed company supervision, stay productive in a remote, high-volume, metric driven reputed company center environment Ability to multi-task and collaborate in reputed company with shifting priorities reputed company are responsible for adherence to the reputed company reputed company of Conduct including the reporting of non-compliance. This position reputed company is designed to be flexible, allowing management reputed company 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 reputed company 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 reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, 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 reputed company position at reputed company. More details about reputed company's reputed company practices can be reputed company at https://www.reputed company/reputed company/reputed company-policy. Apply To This Job