Utilization Management Support Technician
Core
Support Utilization Management leadership by facilitating coverage requests, entering authorizations, and managing communications between members, providers, and the UM team.
Role type
Pharmacy Technician (Utilization Management)
Builds
Prior authorizations, patient assistance program enrollments, and prescription fulfillment coordination for specialty management programs.
Domain
Pharmacy Benefit Management (PBM) / Healthcare
Required skills
Pharmacy claims adjudication, benefit design terminology, call center operations, multi-tasking, regulatory compliance, privacy standards
Preferred skills
Mail order or specialty pharmacy experience, Associate's or Bachelor's degree
Technologies
Claims platform
Responsibilities
Facilitate utilization management requests for coverage, enter authorizations into the claims platform, coordinate prior authorizations and patient assistance programs, make outbound calls to providers for clinical information, ensure cases meet state/federal guidelines and turnaround times, participate in quality review processes, answer prescriber inquiries about UM request status (via careerplan.io/jobs/7789969003-utilization-management-support-technician-at-rightwayhealthcare)
Seniority
Junior, individual contributor