Summary
Overview
Work History
Education
Skills
Timeline
Generic

Danielle Ramirez

Farmington

Summary

Accomplished Pharmacy Operations Manager with a proven track record at Molina Healthcare, excelling as Subject Matter Expert in pharmacy benefits, claims, federal and state compliance regulations. Exceptional performance and operational efficiency through analytical thinking and effective problem-solving. Demonstrated success in PBM oversight, implementation, training, and ensuring compliance of pharmacy services.

Overview

11
11
years of professional experience

Work History

Pharmacy Operations Manager

Molina Healthcare
11.2020 - Current
  • Managed team of Internal Monitor's ensuring consistency with quality monitoring and claims oversight.
  • Support and provide compliance reporting requirements including internal and external audits.
  • Provided oversight of PBM to ensure accuracy of plan benefit set-up.
  • Collaborated with internal and external partners on issue resolution, training, and various projects.
  • Assisted in the development and maintenance of policies and procedures related to pharmacy services.
  • Ensured compliance with state and federal regulations, maintaining a thorough understanding of evolving legislation impacting pharmacy services.

Pharmacy Operations Supervisor

Molina Healthcare
04.2019 - 11.2020
  • Supervised team of Pharmacy Technician's and then Internal Monitor's due to role change.
  • Established and maintained effective communication with staff.
  • Evaluated staff performance regularly to ensure they meet established goals while providing coaching or corrective action when necessary.
  • Developed training material and implemented internal reporting processes.
  • Ensured compliance with state and federal regulations.

Internal Monitor

Molina Healthcare
04.2016 - 04.2019
  • Performed quality monitoring of Pharmacy Technicians and Pharmacy Service Representatives.
  • Reviewed claims and prior authorization reports for accuracy and to ensure compliance.
  • Developed training materials and trained staff.
  • Researched and provided resolution for complex issues.
  • Provided data and support for compliance reporting requirements including audits.

Pharmacy Technician

Molina Healthcare
10.2014 - 04.2016
  • Performed review of prior authorization and non-formulary drug requests with strong commitment to accuracy and quality.
  • Reviewed daily denied claims report to ensure appropriate rejections.
  • Accurately entered overrides for approved drug requests in pharmacy claims system.
  • Provided training to new Pharmacy Technicians.
  • Collaborated with Enrollment Team on identified issues and resolution.

Pharmacy Service Representative

Molina Healthcare
09.2013 - 10.2014
  • Provided exceptional customer service addressing member, provider, and pharmacy inquiries promptly.
  • Demonstrated extensive knowledge of plan benefits and pharmacy claims.
  • Assisted with annual benefit testing ensuring plan accurately coded.
  • Provided training to new Pharmacy Service Representatives.
  • Collaborated with Enrollment Team on identified issue resolution.

Education

Certified Pharmacy Technician - Pharmacy Technician

PTCB
Utah
10.2014

Skills

Advanced pharmacy claims knowledge

Performance Metrics Monitoring

Pharmacy operations management

CMS Compliance Regulations

Problem-Solving

Attention to Detail

Team Collaboration

Decision-Making

Timeline

Pharmacy Operations Manager

Molina Healthcare
11.2020 - Current

Pharmacy Operations Supervisor

Molina Healthcare
04.2019 - 11.2020

Internal Monitor

Molina Healthcare
04.2016 - 04.2019

Pharmacy Technician

Molina Healthcare
10.2014 - 04.2016

Pharmacy Service Representative

Molina Healthcare
09.2013 - 10.2014

Certified Pharmacy Technician - Pharmacy Technician

PTCB

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Danielle Ramirez