Utilization Management Technician – Temp-to-Hire

Capital Rx

Utilization Management Technician at Judi Health validating prior authorization requests for pharmacy. Collaborating with providers to ensure clinical guidelines are addressed and paperwork is complete.

Posted 6/24/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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 requirements required
National Certified Pharmacy Technician (CPhT) license, required
High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred
Excellent communication, writing, and organizational skills
Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
Ability to multi-task and collaborate in a team with shifting priorities

Benefits

Comp & perks

Health insurance
Retirement plans
Paid time off
Flexible work arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

pharmacy technician experienceprior authorization requestspharmacy claims data analysis

Soft Skills

communication skillswriting skillsorganizational skillsindependent workmulti-taskingcollaborationcustomer satisfactionproblem resolution

Certifications

National Certified Pharmacy Technician (CPhT)high school diplomaAssociate’s degreebachelor’s degree