Utilization Management Support Technician

Responsibilities

• Facilitate utilization management requests for coverage and enter authorizations into the claims platform
• Support members in specialty management programs by coordinating prior authorizations and patient assistance programs
• Coordinate UM activities with pharmacy technicians, pharmacists, and medical directors
• Conduct outbound calls to provider offices to obtain missing clinical information
• Ensure cases are reviewed according to State and Federal guidelines and turnaround times
• Participate in quality review and inter-rater reliability processes
• Answer prescriber inquiries regarding UM request status via the provider call center
• Maintain regulatory and privacy standards

Requirements

• 1-2 years of experience as a pharmacy technician in a PBM, health plan, or managed care setting
• Or 1-2 years of experience in mail order or specialty pharmacy
• Active National Certified Pharmacy Technician (CPhT) certification
• Knowledge of pharmacy claims adjudication and benefit design/terminology
• Experience in a call center environment
• Ability to multi-task and work independently

Preferred Qualifications

• Associate’s or Bachelor’s degree

About the Company

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Their products guide patients to the best care and medications through a modern, mobile app, providing on-demand access to health guides and human experts.