Utilization Management Technician – Temp-to-Hire

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Capital Rx

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2017

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Capital Rx is the fastest growing healthtech company in America, dedicated to transforming the prescription pricing and patient care landscape. Founded in 2017, it offers innovative pharmacy benefit management (PBM) services, including customizable pharmacy benefits for large employers and an AI-powered care navigation platform. Capital Rx focuses on delivering cost-effective solutions and operational efficiencies to clients while ensuring transparency and quality care for patients.

📋 Description

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines • Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review • Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. • Review and analyze pharmacy claims data for proactive outreach and intervention. • Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team • Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. • Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders. • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies • Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment

🎯 Requirements

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting • Experience handling prior authorization requests/understanding of prior authorization requirements required • National Certified Pharmacy Technician (CPhT) license, required • High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred • Excellent communication, writing, and organizational skills • Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment • Ability to multi-task and collaborate in a team with shifting priorities

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements