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Utilization Manager Appeals Technician (Temp to Hire)

2 months, 1 week ago
United States
Full-time
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

  • Take incoming requests for first-, second-level, and external appeals.
  • Review cases to determine whether they qualify for appeal review.
  • Maintain quality, productivity, and turnaround time standards across all cases.
  • Follow internal standard operating procedures and HIPAA guidelines.
  • Update case types, send appeal acknowledgements, and submit case information to independent review organizations.
  • Communicate with appeal pharmacists regarding internal and external appeals.
  • Contact members and providers to obtain needed information for case review and document call details accurately.
  • Provide complete and accurate information to members and providers via phone and other communication channels.
  • Perform triple-check quality reviews to ensure proper handling in accordance with policies and procedures.
  • Complete other related duties as assigned.

Requirements

  • 1+ years of experience as a certified pharmacy technician in a managed care or PBM setting.
  • Active, unrestricted certified pharmacy technician license.
  • Strong organization and attention to detail.
  • Strong oral and written communication skills.
  • Ability to work independently with minimal supervision in a remote, high-volume, metric-driven environment with shifting priorities.
  • Ability to work 12pm-9pm EST.
  • Experience working with commercial and Medicare appeals preferred.

Benefits

  • Remote position in the US.
  • Base salary range of $60,000-$65,000 for remote US candidates.
  • Base salary range of $78,800-$98,500 for New York, NY.
  • Base salary range of $72,000-$90,000 for Denver, CO.

Interested in this position?

Apply directly on the company website

Apply Now

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