Utilization Manager Jobs in Monroe, NC (NOW HIRING)

About Judi Health
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.
Position Summary:
We are seeking a dynamic and experienced pharmacist trainer to join our team. As a pharmacist Trainer, you will play a pivotal role in developing and delivering training programs that enhance knowledge, operational efficiency, and customer service skills to our pharmacist staff. The successful candidate will have a strong background in pharmacy practice, a passion for education and the ability to create engaging and impactful training content.
Position Responsibilities:
• Facilitate the onboarding process for new hires and provide comprehensive training sessions for pharmacists on prior authorization systems, processes, and procedures utilizing a variety of training methods.
• Develop and update training materials, resources, verbiage templates, job aids, and communicate updates to the team.
• Ensure that training content is accurate, up-to-date, clinically relevant, compliant with federal and state regulations, and internal policies.
• Maintain detailed records of training sessions, participant attendance, and training materials for auditing and reporting purposes.
• Assess performance of pharmacists through evaluations, quizzes, and practical assessment to identify areas for improvement and provide constructive feedback.
• Collaborate with pharmacy managers, supervisors, and other relevant stakeholders to identify training needs, performance gaps and ensure alignment with company goals.
• Make clinical prior authorization and appeals determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.
• Provide detailed and thorough documentation in prior authorization cases, overrides and call center cases.
• Perform peer-to-peer reviews with providers when requested.
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers.
• Effectively communicate issues and resolutions to members, pharmacies, providers, and appropriate internal stakeholders.
• Provide backup support to call center team as required.
Required Qualifications:
• A Doctor of Pharmacy (Pharm.D.) degree or Bachelor of Pharmacy degree from an accredited pharmacy program.
• An active unrestrictive pharmacist license.
• 3+ years of experience as a clinical pharmacist in Pharmacy Benefit Management (PBM) setting.
• Previous experience developing and delivering training programs.
• Solid understanding of prior authorization operations, Federal and State laws, and regulations.
• Excellent written communication and presentation skills to effectively convey complex information to diverse audiences.
• Excellent analytical skills and attention to detail.
• Ability to collaborate effectively with cross-functional teams and adapt to changing priorities.
• Proficiency in using e-learning platforms, multimedia tools, and Microsoft Office Suite.
• Ability to work a flexible schedule independently with minimal supervision, staying productive in a remote, high-volume, and metric driven call center environment.
This range represents the low and high end of the anticipated base salary range for the NY - based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.
New York, NY Salary Range
$135,000-$145,000 USD
Denver, CO Salary Range
$135,000-$145,000 USD
Charlotte, NC Salary Range
$135,000-$145,000 USD
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.