Experienced with navigating prior authorization processes to ensure patient access to necessary medications. Utilizes in-depth knowledge of insurance policies and healthcare regulations to overcome barriers. Track record of fostering collaboration among healthcare providers and insurance companies.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Clinical Services Pharmacist
Remedi Seniorcare Pharmacy
2017.04 - Current
Supported the CAC/Procare and CSC/Remedi acquisition and merger
Complete prior authorizations for Long Term Care patients and providers
Reduced medication costs for patients and LTC facilities by analyzing insurance formularies and identifying appropriate medication changes.
Determined appropriateness of medication switches based on insurance coverage vs. prior authorization needs.
Communicated insurance coverage criteria to providers, pharmacies, and LTC facilities for non-covered medications.
Assisted providers and facilities with appeals processes.
Documented medication changes and guided technicians on when to initiate prior authorizations.
Identified appropriate use of insurance overrides and managed technicians on selecting alternative medications for testing under patient insurance plans.
Contributed to operational cost-reduction initiatives for the pharmacy.
Pharmacy Intern
Walgreens
2013.07 - 2017.04
Performed foundational intern duties including prescription processing, patient counseling, and customer service.
Conducted MTMs, administered vaccinations, and processed verbal prescriptions and transfers.
Resolved insurance issues and completed OARRS reports for controlled substances.
Assisted with OTC recommendations and basic compounding.
Pharmacy Technician
Wal-Mart
2013.04 - 2013.06
Cashier
Coney Island
2010.06 - 2012.08
Education
PharmD -
Ohio Northern University
01.2017
Skills
Prior authorization & formulary management
Medication cost-reduction strategies
LTC pharmacy operations
Clinical decision support & interdisciplinary collaboration
Patient counseling & education
Leadership, teamwork, and workflow optimization
Clinical medication management
Prior authorization processing
Certification
Registered Pharmacist with the Ohio State Board of Pharmacy
Registered Pharmacist with the Virginia State Board of Pharmacy
CLINICAL SPECIALTY PHARMACIST-CENTER OF EXCELLENCE at United Healthcare-Optum Patient ServicesCLINICAL SPECIALTY PHARMACIST-CENTER OF EXCELLENCE at United Healthcare-Optum Patient Services