Metro PlusHealth 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, Metro Plus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, Metro PlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, Metro Plus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
Metro Plus Health is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
The Prior Authorization Review Technician is responsible for inputting, providing notification for and reviewing prior authorization requests. The Prior Authorization Review Technician is also responsible for entering and auditing overrides input in the Pharmacy Adjudication system, answering member inquiries and assisting in all relevant Pharmacy department deliverables.

• 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 Metro Plus Health Pharmacy and Medical Benefit

• Associate’s degree with four years’ experience as a Pharmacy Technician required; or
• A satisfactory equivalent combination of education, training, and experience.
• 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 Power Point is required.
• Proficiency with MS Access is preferred.
• PTCB or Ex CPT Pharmacy Technician Certification, required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

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