
Purpose-driven Pharmacist with 20+ years of clinical and operational experience in retail, hospital, and long-term care pharmacy. Experienced in prior authorization (PA), utilization management (UM), formulary review, step therapy, and quantity limit determinations. Skilled at clinical evaluation, provider consultation, and documentation of UM decisions. Strong verbal and written communication, remote workflow management, and adherence to regulatory and compliance standards.
- Prior Authorization & Utilization Management (PA, Step Therapy, Quantity Limits)
- Clinical Evaluation of Medication Therapy & Coverage Requests
- Formulary Exception & Tier Exception Review
- Provider Consultation & Collaboration
- Drug Utilization Review & Medication Safety
- Documentation & Regulatory Compliance (HIPAA, CMS)
- Managed Care & PBM Experience
- Remote & Independent Workflow Management
- Microsoft Office & EHR/Pharmacy Systems