Supervisor, Utilization Management Technician at Capital Rx

<div class="content-intro"><h2><strong>About Judi Health</strong></h2> <p>Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:</p> <ul> <li><strong>Capital Rx</strong>, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,</li> <li><strong>Judi Health™</strong>, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and</li> <li><strong>Judi®</strong>, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.</li> </ul> <p>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 <a href="https://www.judi.health">www.judi.health</a>.</p></div><p><strong>Location: </strong>Remote (For Non-Local) or Hybrid (Local to NYC area)</p> <p><strong><u>Position Responsibilities:</u></strong></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Responsible for overseeing a group of prior authorization technicians and expanded responsibility for&nbsp;select&nbsp;administrative PA functions.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Work in conjunction with the pharmacy technician manager in analyzing available data and provide prior authorization staffing, workflow and system enhancement recommendations.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Support on-going training and coaching of u</span><span data-contrast="auto">tilization management</span><span data-contrast="auto"> pharmacy technicians.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Participate in the goal setting process and regularly review performance of direct reports, addressing performance and behavioral issues when needed.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Investigate/resolve escalated issues or problems from clients and providers.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Works with&nbsp;</span><span data-contrast="auto">utilization management</span><span data-contrast="auto">&nbsp;manager on other responsibilities, projects,&nbsp;implementations&nbsp;and initiatives as needed.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Review pharmacy claims data for proactive outreach and intervention.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Maintain quality and productivity standards for all cases triaged while minimizing compliance risk.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Work with business and clinical partners as needed.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="11" data-aria-level="1"><span data-contrast="auto">Proactively obtains clinical information from prescribers, referral coordinators, and&nbsp;appropriate staff&nbsp;to ensure all aspects of clinical guidelines are addressed for pharmacist review.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="11" data-aria-level="1"><span data-contrast="auto">Identify, document, and escalate provider concerns to the appropriate internal team including various members of the u</span><span data-contrast="auto">tilization management</span><span data-contrast="auto"> team.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="13" data-aria-level="1"><span data-contrast="auto">Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="13" data-aria-level="1"><span data-contrast="auto">Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="13" data-aria-level="1"><span data-contrast="auto">Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="13" data-aria-level="1"><span data-contrast="auto">Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="13" data-aria-level="1"><span data-contrast="auto">Ability to work in a fast-paced environment with shifting priorities, and flexible schedules that may include weekends.</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" data-aria-posinset="13" data-aria-level="1"><span data-contrast="auto">Ability to work flexible schedules that includes an on-call weekend&nbsp;</span><span data-contrast="auto">and holiday&nbsp;</span><span data-contrast="auto">rotation.</span><span data-ccp-props="{}">&nbsp;</span></li> </ul> <p><span data-ccp-props="{}">&nbsp;</span></p> <p><strong><u>Required Qualifications:</u></strong></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="8" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">At least 1 year of Medicare experience, including working knowledge of policies and guidelines</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="8" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Minimum 1 year of Medicare Prior Authorization and/or Medicare appeals experience</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="8" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Demonstrated ability to communicate effectively and manage team priorities</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="8" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Strong organizational and problem-solving skills</span><span data-ccp-props="{}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="8" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1">Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required</li> <li>Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint</li> <li>Strong clinical background required</li> <li>Excellent communication, writing, and organizational skills</li> <li>Ability to multi-task and collaborate in a team with shifting priorities</li> </ul> <p>&nbsp;</p> <p><strong><u>Preferred Qualifications:</u></strong></p> <ul> <li>2+ years of leadership experience</li> <li>Strong understanding of CMS regulations and payer requirements</li> <li>2+ years of PBM or Managed Care pharmacy experience&nbsp;</li> </ul> <p>&nbsp;</p><div class="content-pay-transparency"><div class="pay-input"><div class="description"><p>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.</p></div><div class="title">Remote, US Salary Range</div><div class="pay-range"><span>$78,400</span><span class="divider">&mdash;</span><span>$85,000 USD</span></div></div></div><div class="content-conclusion"><p class="p1"><em>All employees are responsible for adherence to the Capital Rx 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.</em></p> <p><em><span data-contrast="none">Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to 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.</span></em><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335559738&quot;:0,&quot;335559739&quot;:0}">&nbsp;</span></p> <p><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335559738&quot;:0,&quot;335559739&quot;:0}">By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at<span class="Apple-converted-space">&nbsp;</span><a href="https://www.judi.health/legal/privacy-policy" data-outlook-id="be5f7242-36ad-42be-9caf-fd585904c3c5">https://www.judi.health/legal/privacy-policy</a>.</span></p></div>