Utilization Management Technician (Healthtech)

TL;DR

Utilization Management Technician (Healthtech): Processing prior authorization requests and managing clinical information for pharmacist review with an accent on clinical guideline validation and provider communication. Focus on gathering substantial clinical data, analyzing pharmacy claims, and maintaining strict HIPAA compliance in a high-volume environment.

Location: Remote (Must be based in the US)

Company

hirify.global is an enterprise health technology company providing a comprehensive suite of health benefit management solutions and a proprietary Enterprise Health Platform for the U.S. healthcare market.

What you will do

• Prepare and validate prior authorization requests based on clinical guidelines and member information.
• Conduct outbound calls to providers and referral coordinators to obtain necessary clinical documentation.
• Analyze pharmacy claims data to perform proactive outreach and interventions.
• Triage inquiries from members, pharmacies, and providers, addressing clinical and drug-specific questions.
• Escalate provider concerns to internal Prior Authorization teams and stakeholders.
• Ensure strict adherence to HIPAA guidelines and internal Standard Operating Procedures.

Requirements

• National Certified Pharmacy Technician (CPhT) license is required.
• 2+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy setting.
• Proven experience handling prior authorization requests and requirements.
• High school diploma or equivalent (Associate’s or Bachelor’s degree preferred).
• Ability to work independently in a remote, metric-driven call center environment.
• Strong communication, writing, and organizational skills.

Culture & Benefits

• Dynamic, fast-paced startup environment.
• Commitment to diversity, equity, and inclusion in the workplace.
• Focus on providing extraordinary customer care with genuine compassion.
• Equal employment opportunity employer.