Utilization Management Support Technician (Healthcare)

TL;DR

Utilization Management Support Technician (Healthcare): Assisting UM leadership in delivering pharmacy benefit management strategies and processing utilization management cases with an accent on prior authorizations and member/provider communications. Focus on coordinating clinical information, ensuring regulatory compliance with state and federal guidelines, and improving the patient healthcare experience.

Location: Remote (US)

Salary: $22.00/hr

Company

hirify.global is a healthcare company on a mission to harmonize care through a modern mobile app and a transparent pharmacy benefit management (PBM) model.

What you will do

• Facilitate utilization management requests for coverage and enter authorizations into the claims platform.
• Coordinate prior authorizations and prescriptions for members enrolled in specialty management programs.
• Collaborate with pharmacy technicians, pharmacists, and medical directors on UM activities.
• Perform outbound calls to provider offices to obtain missing clinical information for cases.
• Ensure all cases are reviewed according to state and federal turnaround time requirements.
• Manage prescriber inquiries via the provider call center regarding UM request status.

Requirements

• Active (National) Certified Pharmacy Technician (CPhT)
• 1-2 years of experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting.
• Experience working in a mail order or specialty pharmacy.
• Knowledge of pharmacy claims adjudication and benefit design terminology.
• Ability to multitask and prioritize work independently in a call center environment.
• Associate’s or Bachelor’s degree preferred.

Culture & Benefits

• Fully remote work arrangement.
• Value-driven culture: being human first, redefining the possible, and cultivating grit.
• Inclusive environment that celebrates diverse backgrounds and thoughts.
• Opportunity to work with a high-growth, venture-backed company.