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UM Support Technician (12/11)

New York, NY 10014 | Fully Remote

Posted: 11/21/2023 Employment Type: Contract Job Category: Customer Service Job Number: 19233 Earning Potential: $22

Job Description


Job ID 19233: Utilization Support Technician

Location: Fully remote 
Approved work locations: FL, GA, TN, TX, Oklahoma, Mississippi, Ohio

Pay: $22.00 per hour

Type: Contract until March 2023

Shifts: You will be assigned a shift  - Open between 8am-9pm
11/21/2023: 
•    10:30am-7pm EST
•    9am-5:30pm EST

Training shift: M-F, 9:00 AM to 5:00 PM EST


Job 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 Certified Pharmacy Technician (CPhT)
  • Must have UM experience
  • Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently.
  • High school diploma or equivalent required
  • Background check required

Meet Your Recruiter

Victoria Helton
Director of Client Services

Hi, I'm Victoria Helton, Director of Client Services. I am happy to discuss your needs and create a pathway to a bright future. Looking forward to connecting. 

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