Utilization Management Support Technician

ABOUT THE ROLE:

The Pharmacy Technician (CPhT) – Utilization Management is a member of the RightwayRx Operations team. This role will assist UM leadership in delivering on our UM strategy and actively work UM cases.

Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. RightwayRx is responsible for designing, building and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers

WHAT YOU’LL DO:

• Support all lines of business via facilitating the process for utilization management requests for coverage, entering authorizations into the claims platform, and facilitating

member and provider communications

• Provides support to members enrolled in specialty management programs, including coordinating any needed prior authorization with the UM team, the fulfillment of the prescription with the specialty pharmacy partner, enrollment in patient assistance programs, and billing questions.
• Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
• Make outbound calls to provider offices to obtain clinical information missing from UM submitted cases
• Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
• Participate in the quality review and inter-rater reliability processes
• Provider call center: answer prescriber inquiries about the status UM requests
• Ensures regulatory and privacy standards are consistently met.

WHO YOU ARE:

• 1-2 years experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting. Or 1-2 years experience working in a mail order or specialty pharmacy
• Active (National) Certified Pharmacy Technician (CPhT)
• Detail-oriented, critical thinker, empathetic, ability to dig deep in understanding an issue to get to true root cause and resolution, desire to improve a patient’s healthcare experience and provide concierge level service.
• Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently.
• Associate’s or Bachelor’s degree preferred

COMPENSATION: $22.00/hr

Compensation offered will be determined by geographic location, experience, and qualifications.

CYBERSECURITY AWARENESS NOTICE

In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment.

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite office…