Utilization Manager Appeals Technician

TL;DR

Utilization Manager Appeals Technician: Managing incoming first, second level, and external appeals for commercial, exchange, and Medicare lines of business with an accent on quality assurance and regulatory compliance. Focus on verifying case qualifications, coordinating with pharmacists and medical directors, and maintaining high productivity in a metric-driven remote environment.

Location: Must be based in the United States

Salary: $60,000–$98,500 USD (varies by location)

Company

hirify.global is an enterprise health technology company providing a comprehensive suite of solutions for pharmacy benefit management and health benefit administration.

What you will do

• Review incoming appeal requests to verify qualification for review.
• Perform triple-check quality reviews in accordance with internal SOPs and HIPAA guidelines.
• Submit case information to independent review organizations and manage appeal acknowledgments.
• Communicate effectively with appeal pharmacists and medical directors regarding case status.
• Conduct verbal outreach to obtain necessary information for case reviews.
• Maintain productivity standards and meet established turnaround time requirements.

Requirements

• Active, unrestricted certified pharmacy technician license required.
• 1+ years of experience in a managed care or PBM setting.
• Must be available to work 12pm-9pm EST.
• Strong detail orientation and organizational skills.
• Ability to work independently in a high-volume, remote environment.
• Excellent oral and written communication skills.

Nice to have

• Experience working with commercial and Medicare appeals.

Culture & Benefits

• Opportunity to work in a mission-driven environment focused on rebuilding trust in healthcare.
• Remote-first work environment with clear productivity metrics.
• Commitment to a diverse and inclusive workplace.
• Professional development within a growing enterprise health platform.