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Utilization Management Technician (Temp-to-Hire)

2 months, 1 week ago
United States
Contract
Junior
Customer Support
Customer and Technical Support
HIPAA
Apply Now
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017
View All Jobs 30

Description

  • Prepare prior authorization requests by validating prescriber and member information, review level, and applicable clinical guidelines.
  • Make outbound calls to providers to gather additional clinical information for pharmacist review and clinical determination.
  • Obtain clinical information from prescribers, referral coordinators, and other staff to ensure clinical guidelines are addressed.
  • Review and analyze pharmacy claims data to support proactive outreach and intervention.
  • Identify, document, and escalate provider concerns to the appropriate internal teams, including the Prior Authorization Team.
  • Triage calls from members, pharmacy personnel, and providers by asking drug- and client-specific clinical questions.
  • Communicate issues and resolutions to members, pharmacy staff, providers, and internal stakeholders.
  • Follow internal Standard Operating Procedures, HIPAA guidelines, and company policies.
  • Support customer satisfaction and quality resolution in a fast-paced, startup environment.

Requirements

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

Benefits

  • Remote, US-based position.
  • Base salary range of $50,000 to $60,000 USD.
  • Opportunity to work for an enterprise health technology company with a mission-focused healthcare platform.
  • Work in a fast-paced startup environment.

Interested in this position?

Apply directly on the company website

Apply Now

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