Utilization Management Support Technician

Job not on LinkedIn

🔥 3 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $22 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📞 Support Engineer

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Rightway

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $100M Series C on 2021-03

Healthcare Insurance • SaaS • B2B

Rightway is a healthcare company focused on providing care navigation and pharmacy benefits management solutions. It specializes in helping employers and health systems lower healthcare costs and improve outcomes through personalized, proactive clinical support and transparent pharmacy benefits management. Rightway offers a human-first approach, providing real-time, one-on-one support to members to help them make better healthcare decisions and navigate the complexities of healthcare systems. The company aims to reduce healthcare costs while improving employee satisfaction with healthcare services.

📋 Description

• Support all lines of business via facilitating the process for utilization management requests for coverage, entering authorizations into the claims platform, and facilitating member and provider communications • Provides support to members enrolled in specialty management programs, including coordinating any needed prior authorization with the UM team, the fulfillment of the prescription with the specialty pharmacy partner, enrollment in patient assistance programs, and billing questions. • Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities • Make outbound calls to provider offices to obtain clinical information missing from UM submitted cases • Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements • Participate in the quality review and inter-rater reliability processes • Provider call center: answer prescriber inquiries about the status UM requests • Ensures regulatory and privacy standards are consistently met.

🎯 Requirements

• 1-2 years experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting. Or 1-2 years experience working in a mail order or specialty pharmacy • Active (National) Certified Pharmacy Technician (CPhT) • Detail-oriented, critical thinker, empathetic, ability to dig deep in understanding an issue to get to true root cause and resolution, desire to improve a patient’s healthcare experience and provide concierge level service. • Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently. • Associate’s or Bachelor’s degree preferred.