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Capital Rx · 1 day ago

Clinical, Manager, Prior Authorization Technician

United States

Full-time

Remote

Mid, Senior Level

$80K/yr - $90K/yr

4+ years exp

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are seeking a Clinical Manager to oversee a team of pharmacy technicians engaged in the prior authorization process, analyze data for staffing and workflow improvements, and ensure compliance with clinical guidelines.

Hospital & Health Care

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

Qualification

National Certified Pharmacy TechnicianPBMManaged Care experienceMicrosoft Office SuiteClinical backgroundMulti-taskCommunication skillsOrganizational skillsCollaboration skills