Pharmacy Authorization Specialist

2 weeks ago


New York, New York, United States MetroPlus Health Plan Full time
Job Summary

MetroPlusHealth is seeking a highly skilled Pharmacy Technician to join our team as a Prior Authorization Review Technician. In this role, you will be responsible for reviewing and processing prior authorization requests, ensuring accurate and timely decision-making. Your exceptional organizational and communication skills will enable you to effectively collaborate with our team and stakeholders.

Key Responsibilities
  • Review and process prior authorization requests, ensuring compliance with internal guidelines and criteria.
  • Provide recommendations for select prior authorization requests, utilizing your expertise and knowledge of pharmacy practices.
  • Respond to inquiries from members, providers, and pharmacies, providing accurate and timely information.
  • Enter and audit medication overrides in the pharmacy adjudication platform, ensuring accuracy and consistency.
  • Support pharmacy case management activities, working closely with our team to ensure seamless care coordination.
  • Participate in departmental quality initiatives, contributing to the continuous improvement of our services.
Requirements
  • Associate's degree with four years' experience as a Pharmacy Technician, or a satisfactory equivalent combination of education, training, and experience.
  • Pharmacy experience in a managed care environment is preferred.
  • Experience in auditing and government programs (Medicare, Medicare Part D, and Medicaid) is also preferred.
  • Proficiency in MS Word, Excel, and PowerPoint is required, with MS Access proficiency preferred.
  • PTCB or ExCPT Pharmacy Technician Certification is required.
Professional Competencies
  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Excellent organizational, teamwork, interpersonal, time management, written, and verbal communication skills are essential for this role.


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