Clinical, Manager, Prior Authorization Technician

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:

• Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process.
• Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance.
• Actively participate in the prior authorization technician metric and quality goal setting process.
• Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders.
• Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees.
• Investigate/resolve escalated issues or problems from team members, clients, and other internal teams.
• Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions.
• Maintain relationships with external Independent Review Organizations and clinical resource vendors.
• Support the training and growth of both new and existing staff members in adherence to proper procedures.
• Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties.
• Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department.
• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
• Maintain compliance with local, state, and federal laws, in addition to established organizational standards.
• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies

Required Qualifications:

• Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
• Bachelor’s or Associate’s degree is preferred
• 4+ years of PBM or Managed Care pharmacy experience 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 regulated market prior authorization operations experience or knowledge of how to operationalize regulated market requirements
• Previous prior authorization operations leadership experience

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.

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. 

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 https://www.judi.health/legal/privacy-policy.