BRIAN J. MOORE
Uniontown,OH
Summary
Highly knowledgeable and patient focused pharmacist with over 30 years of healthcare experience. Expert multi-tasker and respected leader skilled in both clinical and supervisory roles. Proven strengths in positive patient relations and effective staff training and development. Excellent communication skills to build and sustain rapport with other health-care professionals, including physicians and hospital administration. Encourages productive work environment and attitudes of service among employees. Knowledge of accreditation processes, including CMS, JCAHO, and Ohio Department of Health. Experience with Medicare D and commercial Pharmacy Benefit Management, including formulary processes and review.
Overview
22
22
years of professional experience
Work History
Senior Manager
Gainwell Technologies, SPBM
08.2022 - Current
- Accomplishes department objectives by managing staff of 20+ pharmacists; plans and evaluates department activities
- Maintains staff by recruiting, selecting, orienting, and training employees
- Ensures a safe, secure, and legal work environment
- Develops personal growth opportunities
- Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results
- Coaches, counsels, and disciplines employees
- Develops, coordinates, and enforces systems, policies, procedures, and productivity standards
- Establishes strategic goals by gathering pertinent business, financial, service, and operations information
- Defines objectives, identifies and evaluates trends and options, chooses a course of action, and evaluates outcomes
- Accomplishes financial objectives by forecasting requirements, scheduling expenditures, analyzing variances, and initiating corrective actions
- Maintains quality service by enforcing quality and customer service standards, analyzing and resolving quality and customer service problems, and recommending system improvements
- Contributes to team effort by accomplishing related results as needed
- Reviews clinical prior authorization and appeal requests in accordance with medical necessity and covered benefit guidelines within established turnaround times
- Provides detailed and thorough documentation in prior authorization cases, overrides, and call center cases
- Performs peer-to-peer (P2P) reviews with prescriber when requested
- Performs scientific literature evaluation using primary drug resources to support decision-making and recommendations to prescriber
- Effectively communicates issues and resolutions to members, pharmacies, prescribers, and appropriate internal stakeholders
- Remains up to date on all communications and updated processes and apply to daily responsibilities
- Follows all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies
- Supports staff training and development as required.
Pharmacy Manager
Easterday Pharmacy
, OH
01.2020 - 07.2022
- Managed work activities, performance and service quality of pharmacy staff
- Managed weekly schedules and requests for leave
- Assessed safety procedures and federal regulations to maintain pharmacy compliance
- Communicated with patients with compassion while keeping medical information private
- Dispensed medications after reviewing and interpreting prescriptions from healthcare providers
- Advised patients on potential drug interactions and side effects, proper dose timing and medication storage
- Discussed over-the-counter medication and equipment options to help patients deal with individual symptoms
- Verified prescription information against safety guidelines and insurance limitations to protect patient health and financial interests
- Improved organization and supply management policies for medicines and materials
- Analyzed prescribing trends to monitor patient compliance and prevent excessive usage
- Secured drugs against theft, loss or mismanagement by setting and enforcing effective procedures
- Ordered supplies needed for pharmacy and kept tabs on inventory levels
- Mitigated regulatory risks by coordinating audits to comply with protocols
- Created and implemented policies and procedures for effective pharmacy management.
Staff Utilization Management Pharmacist
Humana
Louisville, KY
10.2018 - 11.2019
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries
- Determined medical necessity and cost-effectiveness of services through utilization review processes
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations
- Remained up to date on various benefit plans, medical policies and state-specific clinical guidelines or criteria
- Referred cases to secondary review for failure to meet established criteria.
Pharmacist, Clinical, Lead Clinical Pharmacist
CVS/Health
Solon, OH
11.2013 - 06.2018
- Reviewed coverage determinations and appeals cases for member clients while ensuring that all requests are processed within stated timelines and in compliance with quality standards
- Coached/Developed staff to achieve quantitative and qualitative performance targets
- Collaborated with staff to identify internal and external customers and their expectations, initiate process changes to increase quality, improve staff, provider and member satisfaction
- Member of team identified to review cases for select client (Capital BlueCross); one responsible for coverage determinations/appeal reviews for client
- Assisted in removal of CMS-enforced sanctions for client by achieving 100% accuracy of coverage determination reviews
- Responsible for daily review of select reports and documentation and reporting of errors by CVS/Health employees (QA)
- Served as weekend supervisor at Solon, OH call center; responsible for staff of approximately 8-10 pharmacists and 10-12 technicians
- Ensured that staff were working in appropriate areas and completing assigned tasks
- Met several times during shift with supervisors at other call centers to determine staff movement to other areas to meet needs of workflow
- Managed QA/Regulatory/Audit team performance and accountability for quality results
- Conducted quality daily audits of tasks handled by CVS CDA pharmacists
- Assisted in management of IRR for both NCQA and internal teams
- Created and maintained Performance Evaluation and Assessment Quality (PEAQ) tracking tool as means of monitoring errors within CDA.
Clinical Pharmacy Specialist
Marymount Hospital
Garfield Heights, OH
08.2005 - 11.2013
- Provided day-to-day clinical pharmacy services to critically ill patients
- Reviewed patient medication profiles for optimal drug therapy
- Attended daily patient rounds as part of multidisciplinary team led by ICU physicians
- Served as drug information resource to health-care professionals
- Responsible for ensuring accurate and safe delivery of medications to inpatient units, including unit-dose, parenteral, and chemotherapy
- Reduced drug costs in Intensive Care Unit by utilizing best pharmacy practices and inventory control (costs reduced by approximately $25,000 annually)
- Managed development and implementation of automated dispensing cabinets for new surgical expansion project (total project cost $75 million)
- Directed development of intensive insulin protocol for critically ill patients
- Developed and implemented therapeutic hypothermia protocol for comatose patients who survived cardiac arrest
- Supervised pharmacy personnel, including pharmacists, technicians and pharmacy interns; assisted with blueprints and construction oversight of new intravenous (IV) admixture area within inpatient pharmacy
- Guided development of Medication Event Subcommittee
- Assisted with hospital-wide transition to electronic medical administration record and computerized physician order entry (CPOE)
- Partnered with health care professionals driven at improving patient care and hospital HCHAP scores, including anti-coagulation/medication reconciliation/DVT prophylaxis, congestive heart failure, acute myocardial infarction, and community acquired pneumonia patient education
- Served as instructor/preceptor for pharmacy students
- Worked with healthcare team to improve patient care through medication use
- Instructed physicians on correct medication dosages
- Delivered pharmacological education to patients by responding to and answering questions and explaining medication side effects
- Reviewed data on medication use and recommended changes to established policies
- Mentored residents and interns in pharmacy on operations, clinical support, medications and other vital job aspects
- Maintained compliance with state and federal drug laws
- Attended healthcare conferences and seminars
- Detected and reported therapeutic incompatibilities.
Regional Director
Pharmacy Systems, Inc
Dublin, OH
04.2002 - 07.2005
- Provided clinical pharmacy consulting services to client hospitals
- Marketed consulting services to potential client hospitals
- Developed and managed clinical pharmacy programs
- Served as drug information resource to health care professionals
- Consistently reduced formulary drug costs at client hospitals, ranging from $10,000 to $250,000 annually
- Met all regulatory compliance for JCAHO standards at repeated surveys
- Collaborated with team members in developing best practices to support company objectives
- Participated in round table discussions to brainstorm business strategies
- Cultivated and maintained industry relationships and customer partnerships to capitalize on opportunities and maximize business success
- Monitored business trend forecasts and adjusted budgets and operational plans to maximize growth and opportunities.
Education
Pharm.D - Pharmacy
The Ohio State University
06.2000
B.S. Pharm - Pharmacy
The Ohio State University
Skills
- Performance management
- Project management
- Quality management
- Coaching
- Supervision
- Results driven
- Strategic planning
- Budget development
- Standards development
- Foster teamwork
- Handles pressure
- Provides feedback
- Promotes process improvement
Accomplishments
- 1991
Affiliations
Member, Society of Critical Care Medicine 2005-2013
Member, American College of Clinical Pharmacy 2005-2013
Lifetime Member, The Ohio State University Alumni Association
Member, The Ohio State University College of Pharmacy Alumni Association, 2000-present
Member, Pharmacy and Therapeutics Committee 2002-2013
Member, Critical Care Committee 2007-2013
Member, Code Blue Committee 2007-2013
Member, Patient Safety Committee 2009-2013
Member, Stroke Committee 2009-2013
Member, Biomedical Ethics Committee 2011-2013
Member, Medication Event Subcommittee 2012-2013
Member, Marymount Hospital Surgery Expansion Committee 2011 Member, Infection Prevention Committee 2012-2013
Member, Cleveland Clinic Health System Critical Care Specialty Panel, 2010-2013
Member, Cleveland Clinic Health System Clinical Integration Committee 2012-2013
Member, Cleveland Clinic Health System Pharmacy Residency Committee 2012-2013
Preceptor, Ohio Northern University School of Pharmacy 2006-2013 Preceptor, University of Toledo College of Pharmacy 2006-2013 Preceptor, The Ohio State University College of Pharmacy 2007-2013 Preceptor, Lake Erie College of Osteopathic Medicine School of Pharmacy 2007-2013
Preceptor, University of Florida College of Pharmacy Working Professional PharmD Program (WPPD) 2011-2013
Timeline
Senior Manager
Gainwell Technologies, SPBM
08.2022 - Current
Pharmacy Manager
Easterday Pharmacy
01.2020 - 07.2022
Staff Utilization Management Pharmacist
Humana
10.2018 - 11.2019
Pharmacist, Clinical, Lead Clinical Pharmacist
CVS/Health
11.2013 - 06.2018
Clinical Pharmacy Specialist
Marymount Hospital
08.2005 - 11.2013
Regional Director
Pharmacy Systems, Inc
04.2002 - 07.2005
Pharm.D - Pharmacy
The Ohio State University
B.S. Pharm - Pharmacy
The Ohio State University