Utilization Management Support Technician

🕒 July 7

🐊 Florida – Remote

🐊 Florida – Remote

💵 $22 / hour

⏰ Full Time

🟢 Junior

📞 Support Engineer

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Rightway

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

💰 $100M Series C on 2021-03

Healthcare • Healthcare Insurance • SaaS

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

• Facilitate utilization management requests for coverage across all lines of business • Enter authorizations into the claims platform • Facilitate member and provider communications • Support members enrolled in specialty management programs • Coordinate prior authorizations with the UM team and prescription fulfillment with specialty pharmacy partners • Support enrollment in patient assistance programs and answer billing questions • Coordinate with Pharmacy Technicians, Pharmacists, and/or Medical Directors on UM activities • Make outbound calls to provider offices to obtain missing clinical information • Ensure cases are reviewed according to State and/or Federal guidelines and turnaround-time requirements • Participate in quality review and inter-rater reliability processes • Answer prescriber inquiries about UM request status through the provider call center • Ensure regulatory and privacy standards are 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, able to understand issues deeply and identify root causes and resolutions • 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