About the role
About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx , a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™ , which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health . Position
Responsibilities: Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. Review and analyze pharmacy claims data for proactive outreach and intervention. Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment Required
Qualifications: 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting Experience handling prior authorization requests/understanding of prior authorization
