PA Review Technician

MetroPlus Health Plan 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, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The Prior Authorization Technician Team Lead is responsible for inputting, providing notification for and reviewing prior authorization requests while also assisting the Technician Supervisor in ensuring the quality of internal pharmacy technicians. The Prior Authorization Technician Team Lead 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 prior authorization requests into the electronic review system, ensuring accurate transcription of all information
• Reviews and provides recommendations for select prior authorization requests following internal guidelines and criteria for review
• 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
• Performs audit of internal overrides, inputted cases, case reviews and all pharmacy technician functions
• Assists in pharmacy case management activities
• Assists the Pharmacy Technician Supervisor in the training and development of internal pharmacy technician staff 
• Supports departmental quality initiatives
• Answers and leads all triaged inquiries regarding MetroPlus Pharmacy Benefit

• Three years’ experience as a Pharmacy Technician, required
• PTCB or ExCPT Pharmacy Technician Certification, required
• Associates or Bachelor’s degree, required
• Pharmacy experience in a managed care environment required
• 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.
• Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communications