Supervisor, Utilization Management Technician

Capital Rx

Supervisor overseeing prior authorization technicians for Medicare at Judi Health providing health technology solutions. Responsible for training, performance reviews, and operational improvements.

Posted 6/24/2026full-timeNew York City • New York • 🇺🇸 United StatesJunior💰 $70,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

Responsible for overseeing a group of prior authorization technicians and expanded responsibility for select administrative PA functions.
Work in conjunction with the pharmacy technician manager in analyzing available data and provide prior authorization staffing, workflow and system enhancement recommendations.
Support on-going training and coaching of utilization management pharmacy technicians.
Participate in the goal setting process and regularly review performance of direct reports, addressing performance and behavioral issues when needed.
Investigate/resolve escalated issues or problems from clients and providers.
Works with utilization management manager on other responsibilities, projects, implementations and initiatives as needed.
Review pharmacy claims data for proactive outreach and intervention.
Maintain quality and productivity standards for all cases triaged while minimizing compliance risk.
Work with business and clinical partners as needed.
Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
Identify, document, and escalate provider concerns to the appropriate internal team including various members of the utilization management 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.
Ability to work in a fast-paced environment with shifting priorities, and flexible schedules that may include weekends.
Ability to work flexible schedules that includes an on-call weekend and holiday rotation.

Requirements

What you’ll need

At least 1 year of Medicare experience, including working knowledge of policies and guidelines
Minimum 1 year of Medicare Prior Authorization and/or Medicare appeals experience
Demonstrated ability to communicate effectively and manage team priorities
Strong organizational and problem-solving skills
Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
Strong clinical background required
Excellent communication, writing, and organizational skills
Ability to multi-task and collaborate in a team with shifting priorities

Benefits

Comp & perks

Health insurance
401(k) retirement plan
Paid time off
Flexible working hours

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Medicare experienceMedicare Prior AuthorizationMedicare appealsclinical guidelinespharmacy claims data reviewproblem-solvingdata analysisstaffing recommendationsworkflow enhancementquality resolution

Soft Skills

communicationorganizational skillsteam managementcustomer satisfactionflexibilitymulti-taskingcoachingperformance reviewissue resolutioncollaboration

Certifications

National Certified Pharmacy Technician (CPhT) license