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Prior Authorization Review Specialist
2 months ago
**Job Summary**
The Prior Authorization Review Technician will be responsible for reviewing and processing prior authorization requests for MetroPlus Health. This role will require strong analytical and communication skills to ensure accurate and timely processing of requests.
**Key Responsibilities**
- Review and process prior authorization requests in accordance with internal guidelines and criteria.
- Provide recommendations for select prior authorization requests.
- Notify providers and members of prior authorization decisions.
- Audit vendor-inputted medication overrides in the pharmacy adjudication platform.
- Assist in pharmacy case management activities.
- Support departmental quality initiatives.
- Answer inquiries regarding MetroPlus Health Pharmacy Benefit.
**Requirements**
- Associate's degree with four years' experience as a Pharmacy Technician required.
- 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 required.
- Proficiency with MS Access preferred.
**Certifications and Licenses**
- PTCB or ExCPT Pharmacy Technician Certification required.
**Professional Competencies**
- Integrity and Trust
- Customer Focus
- Functional/Technical Skills
- Excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills required.
