Eunique Lane
Plantation,USA
Summary
Strategic pharmacist with experience and managed care, pharmacy, operations, and value based performance improvement across Medicare and Medicaid. Skilled and translating clinical and claims data into actionable provider strategies that improve quality measures, medication use, and total cost of care. Positioned to step into a management role, focused on operational leadership, cross, functional collaboration, and scale healthcare performance improve improvement.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Clinical Pharmacist
Elevance Health
Miami, FL
08.2025 - Current
- Lead pharmacy performance strategies for 30+ Medicare and Medicaid provider groups, overseeing quality improvement, medication, adherence, patient, safety, utilization, and cost of care performance.
- Analyze, pharmacy and quality data to identify performance gaps, drugs, spares, formulary opportunities, and provide provider specific intervention strategies.
- Develop and deliver quarterly business review reviews, provider, presentations, and ad hoc executive ready analysis focusing on improving Medicare stars measure, and Medicaid pharmacy cost performance.
- Leverage Power BI, Tableau and Excel to build, interpret and present provider level and market level performance insights related to medication adherence, patient, safety, pharmacy, utilization, and PMPM spend.
- Serve as a strategic consultant to provide a groups by translating complex, clinical and financial data into actionable plans for quality improvement, utilization management, and prefer drug optimization.
- Drive targeted interventions related to medication adherence, SUPD, COB, poly ACH, formulary compliance, generic conversion, and high cost drug utilization.
- Develop and present actionable, dashboards and scorecard summaries to monitor key metrics, including PMPM, cost/script, and total drugs spend.
- Educate providers and stakeholders on quality measures, pharmacy, trend, drivers, preferred drug opportunities, and best practices to improve member outcomes and reduce unnecessary spend.
- Influence provide provider engagement and accountability by highlighting, key performance, drivers tracking opportunities, and aligning recommendations to organizational and market benchmarks.
- Partner cross functionally with clinical, quality, and operational teams to support strategy development, performance, improvement, and enterprise education initiatives.
- Produce polished, high visibility, presentations for leadership and provider audience that supports strategic planning, performance, oversight, and decision-making.
Clinical Pharmacist
Memorial Healthcare System – Ambulatory & Population Health
Miramar, FL
08.2023 - 01.2026
- Provide value-based medication management services to Medicare, Medicare Advantage, and Accountable Care Organization (ACO) plans guided by the CMS’s guidelines. Ensure compliance with respective state Medicare plan contract requirements
- Medication adherence – monitor fill history and maintain medication compliance (PDC > 80%) for over 600 patients, including non-insulin diabetic agents, renin-angiotensin-aldosterone system (RAAS) agents, and statins to achieve 5-star quality ratings
- Statin-Use Measure – present American College of Cardiology and American Heart Association (ACC/AHA) guidelines to multiple providers regarding the primary recommendation of Statins for the primary prevention of CVD in patients with ASCVD and diabetes diagnosis. Over 40 providers accepted the patient-specific recommendation and sent in moderate- to high-intensity statins
- Antidepressant Medication Management (AMM) measure – emphasize the importance of effective clinical management in increasing compliance, monitoring treatment effectiveness, and manage side effects. Help achieve 5 stars for acute and continuation treatment phase in those newly treated with antidepressants
- Assist with the Transition of Care services to Medicare All Cause (MAC) and a Medicare ACO population by providing post-discharge assessments, follow-up care with the medical team, improve patient health outcomes with patient education, evaluate risks that impede medication access, identify and remove medication barriers, refer patients to social work and reimbursement specialist, identify and resolve clinical care gaps
- Data collection Availity and Tableau business intelligence and analytics software
- Utilize RxEffect, an intervention program, while tracking and monitoring financial incentives after initiating services following Star ratings medication therapy areas: diabetes, blood pressure, and cholesterol
- Guide and instruct APPE students on value-based programs and assign clinical tasks to improve their documentation skills via EHR, assess their judgment for clinical appropriateness of Statins in high ASCVD risk, and request weekly drug information questions
- Collect, interpret, and organize patient data from business intelligence and analytical software such as Tableau and Availity
Clinical Pharmacist
HCA Florida Mercy Hospital
Miami, FL
12.2022 - 02.2025
- Utilize automatic medication dispensing system, Pyxis MedStation, to keep track of medication stock and collaborate with pharmacy technicians to keep the entire hospital equipped with medications and devices
- Navigate patient information using EHR Meditech to assess appropriate of therapy while verifying medications including but not limited to NICU, ICU, CVICU, ER, radiology, chemotherapy and hospice patients
- Monitor therapy regimens for contraindications, drug-drug interactions, drug-food interactions, drug-laboratory test interactions, allergies, appropriateness of drug and dose, indications, and therapeutic duplications
- Ensure accurate interpretation of verbal/written medication orders and accurately interpret them into the electronic health record profiles in accordance with HCA practice and guidelines
- Monitor our electronic clinical surveillance platform, Vigilanz, for discrepancies, monitoring parameters, IV to PO medication and other clinical risk management solutions
- Follow established policies, procedures, and protocols when preparing and dispensing medication orders on behalf of physicians or authorized clinicians
- Collaborate with other healthcare professionals within a multidisciplinary rounding team to reduce fragmentation of care and close unmet care gaps
- Given the responsibility of tracking pharmacokinetics in patients taking antibiotics such as vancomycin until patients were discharged
- Ensure controlled substances are distributed to patient care areas adequately and maintain records or files with reasonable precautions
- Promote clinical experience, expertise, and professional judgement as a patient advocate to implement exceptional pharmaceutical care
- Select and utilize medications safely, effectively, and cost effectively based on evidence-based practices and literature
- Access and verify CPOE orders for accuracy and appropriateness or intervened if orders are unclear or inappropriate
- Up-to-Date core competencies of calculations, measure/mixing, material transfer, hand hygiene, garbing, principles of unidirectional HEPA filtration, use if PECs or other equipment, anti-septic technique, maintaining sterility, documentation, and cleaning/disinfecting
- Utilize DoseEdge, the IV workflow management system, to verify patient-specific drips and stock for accuracy of dilution, rate, compatibility, filtration, final concentration
- Provide safe and accurate preparation and dispensing of sterile, chemotherapy, and TPN medications according to USP , & standards
- Responsible for compounding stock/inventory of critical drips for cardiovascular ICU, neonatal ICU, ICU, labor & delivery
- Create order sets for new medications on DoseEdge by FDA-approved package insert’s stability and reconstitution standards
- Daily non-viable monitoring of temperature, humidity and pressure gradient
PGY-1 Managed Care Resident
Community Care Plan – Health Plan
Sunrise, FL
07.2022 - 06.2023
- Contribute to increasing the HEDIS score measures by contacting members who started ADHD medication to make a follow-up doctor’s appointment in 30 days. Contact members with a diagnosis of schizophrenia, schizoaffective, antidepressants for continued psychotropic medication adherence. Provide MTM services, improve the per member per month spend as it relates to overall patient care and improved clinical outcomes.
- Provided comprehensive Medication Therapy Management (MTM) for over 300 patients with complex drug regimens (> 5 medications). Common conditions managed include diabetes, anticoagulation, hypertension, asthma, COPD, osteoporosis, benign prostate hyperplasia (BPH), etc. Medication action plans (MAPs) were made based on Centers for Medicare & Medicaid Services (CMS) guidelines following a completed consultation to assist with selfmanagement for the patient. Follow-ups with providers made if medication-related issues were detected
- Assess for gaps in therapy, drug-drug interactions, drug-disease state interactions, drug-food interactions, duplication of therapy, inconsistency with adherence, inappropriate prescribing practices, untreated diseases or conditions, medication cost considerations, etc.
- Review pharmacy and medical claims data and recommend improvements for care and utilization, implement strategies to affect positive clinical and/or financial outcomes based on recommendations, measuring reporting results, including on-site education and training for regional providers and pharmacists
- Manage the health plan’s retrospective and prospective medication referrals involving the Healthcare Common Procedure Coding System Level II J-codes claims for the medical billing of non-oral Oncology, inflammatory and other diseases states
- DUR, medical necessity and dosing reviewed before each approval or denial
- Created value-based programs for ADHD, MDD and, Schizophrenia due to high hospital re-admission rate in this population. Hospital readmit rates decreased by 30 percent across each disease state and improved HEDIS scores
- Develop and implement clinically appropriate utilization management criteria (e.g., prior authorization, steptherapy, quantity limits, and drug utilization review (DUR) edits to enhance patient care)
- Counseled members on important considerations when on certain medications such as, increased bleeding with blood thinners, signs of digoxin toxicity, and proper instructions on using inhalers
- Design a safe and effective individualized patient-centered care plan in collaboration with other health care professionals, the patient, and caregivers
- Provided monthly data analysis with PBM Magellan Health and Southern Scripts regarding medication trends and top 10 high-costing medications
- Established M8 program, designed to alert PBM and CCP pharmacy team to conduct comprehensive medication reviews (CMRs) if an 8th medication is prescribed while member is on high-cost medication
- Over 100 medications, including the top 10 high costs, have been removed due to inappropriateness, duplication of therapy and better/low-cost alternatives
- Review CAHPS scores and their impact on healthcare outcomes (i.e., member complaints of not being able to fill scripts at the pharmacy)
- Assess each medication for appropriateness, effectiveness, safety, and patient adherence during medication therapy management (MTM).
- Gain more understanding of NCQA standards within the pharmacy clinical programs: SAA, AMM, and ADHD
- Notion to approve or deny non-expedited Grievance & Appeal cases submitted by provider during monthly
- Participate in the process used to evaluate and effectively handle member complaints via CMS and CRMs.
- Resolved over 50 medication-related claims based on prior authorization requests
- Manage aspects of the medication-use process related to formulary management
- Worked with MHS’s 6 acute care hospitals, 10 primary care practices and multiple specialty group practices.
- Modulated four Medication Use Evaluation (MUE) for Sitagliptin providing utilization management using a pivot table, cost saving strategies, criteria for use protocol and provider counseling on these changes at quarterly P&T committees
- Assigned patients in MHS’s systems population health value-based efforts aim to achieve positive clinical, financial, and humanistic outcomes for patients Broward Guardian accountable care organization, Primary Care Value based contract members and Oscar Holy Cross/MHS Medicare Advantage Members
- Assisted in Collaborative Practice Agreement (CPA) design in the delivery of patient-centered care to support optimal medication therapy outcomes utilizing evidenced-based medicine, pharmacy practice laws and protocols to drive clinical pharmacy practice
- Conducted Comprehensive Medication Review (CMR) to identify medication therapy problems (MTPs) and nonmedication related problems along with Targeted Medication Reviews (TMRs) for over 75 patients
- Patient population: patients include MHS Primary Care, ACO, and Population Health Programs (Hospital Readmission Reduction Program (HRRP) and Bundle Payment for Care Improvement (BPCI)), as well as patients enrolled in the MHS/Oscar Health Medicare Part C Plan
- Train Clinical Specialist on new electronic medical records system EMR from CareTends to Epic EHR system
- Counsel Outpatient pharmacists to honor Variable Co-pay Programs (VCPs) for cost-saving initiatives that benefit MHS consumers and lower overall medication cost that the pharmacy pays per prescription
- Decrease Direct and Indirect Remuneration Fees by 10% in one quarter by initiating MTM services to increase proportion of days covered (PDC) > 90 percent
- Presented 5 new FDA-approved medications to P&T committee and Specialty formulary via drug monographs and assignment into EHR and billing protocol
- Conduct price overrides for over 50 medications by investigating appropriate dose, indication and medical necessities
- Maintain follow-up parameters for over 50 patients receiving treatment in the FSCDR clinic, including management of MTMs, CMRs and hospital discharge medication changes
- Reported medication regimens to clinical trial manufacturers for patients on investigational therapies including PF07029326, FTX-6058, ALXN1820, Etavopivat, and VIT-2763-SCD-202
- Prior authorization forms were documented and kept up to date for over 20 patients
- Manage historical records of opioid use and mandated Narcan for chronic use
Education
Doctor of Pharmacy - undefined
Florida Agricultural and Mechanical University
Tallahassee, FL04.2022
Skills
Value-Based Care
Medication Optimization
Population Health Strategy
Cross-Functional Healthcare Collaboration
Cost/Utilization Management
Medicare/Medicaid Performance
Certification
- Pharmacist License (PS 64908) NABP ID (1397453), State of Florida Department of Health
- Consultant Pharmacist (PU 9887)
- HIV 500/501 Counselor Certification, Florida Department of Health
- Immunization Certification, American Pharmacist Association
PUBLICATIONS
- Pharmacists’ Role in Using Claims Data to Resolve Unaddressed Medication Issues: An Interactive Study Using Text Messaging Eunique Lane [Florida Residency Conference Presentation – 2024-05-08]
- Case Report: Escapade of Errors Lead to Patient Death Eunique Lane, Leonard Rappa, PharmD
- Abbot Real Time IDH2
Timeline
Clinical Pharmacist
Elevance Health
08.2025 - Current
Clinical Pharmacist
Memorial Healthcare System – Ambulatory & Population Health
08.2023 - 01.2026
Clinical Pharmacist
HCA Florida Mercy Hospital
12.2022 - 02.2025
PGY-1 Managed Care Resident
Community Care Plan – Health Plan
07.2022 - 06.2023
Doctor of Pharmacy - undefined
Florida Agricultural and Mechanical University