Prior Authorization Review Technician

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

• Inputs all received medical benefit and pharmacy benefit prior authorization requests into our processing platforms, ensuring accurate transcription of all information
  Reviews and provides recommendations for select prior authorization requests following internal guidelines and criteria for review
  Answer inquiries from, but not limited to, members, providers and pharmacies received from our pharmacy call center line
  Provides verbal notification of prior authorization decision and inputs accurate medication overrides in the pharmacy adjudication platform
  Performs audit of vendor-inputted medication overrides in the pharmacy adjudication platform
  Assists in pharmacy case management activities
  Supports departmental quality initiatives
  Answers all triaged inquiries regarding MetroPlusHealth Pharmacy and Medical Benefit

• Associate’s degree with 3 years’ experience as a Pharmacy Technician. Bachelor’s degree preferred

• OR High school diploma/GED with 5 years’ experience as a Pharmacy Technician.

• Pharmacy experience in a managed care environment preferred

• Experience in auditing preferred

• Experience in government programs (Medicare, Medicare Part D, and Medicaid) preferred

• Proficiency with MS Word, Excel, and PowerPoint is required.

• Proficiency with MS Access is preferred