HaMy Vo, PharmD

Make clinical prior authorization of specialty medication and appeal determination in accordance with medical necessity and covered benefits guidelines within established turnaround time.

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Provide detailed and thorough documentation in prior authorization cases, and overrides.

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Perform clinical reviews of Specialty Medication’s Prior Authorizations, Step Therapy, Quantity Limit and all other pharmacy utilization requests in accordance with quality, timeliness and efficiency standards.

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Perform scientific literature evaluation using primary, secondary and tertiary drug resources to support decision making and recommendations to providers.

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Collaborate with internal and external Medical Director in administrating appeals review.

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Serve as a resource pertaining to the Prior authorization and appeals process of Specialty and Auto- Immune medications

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Evaluate patient chart and progress notes and interpreted clinical evidence and practice guidelines

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Provided medical recommendation and clinical rationales to providers when rendering decision

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Performs prospective and/ retrospective drug utilization review and appeals per State and Federal regulations

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Participates in the distribution of clinical drug information and educates providers and staff regarding the use of pharmaceutical treatment regimens

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Provided consultation on evidence-based guidelines and pharmacy policies to physician and staff

•Oversee processing billing and dispensing for the Tampa Bay Buccaneers NFL Team.

•On call pharmacist for home games.

•Collaborate with sport medicine providers in care of team medication needs.

•Available for emergency services

* Oversee daily pharmacy operational duties are compliant and up to standards and regulations.

*Ensure processes for the store are properly documented ensuring readiness for audit and/or inspections.

* Protect pharmacy from insurance chargeback by ensuring no discrepancies, appealing and closing insurance audits from PBMs

* Assist in prior authorizations, appeals and application of manufacture coupons with linkage to treatment.

* Assist medical offices in obtaining prior authorizations, composing letter's of medical necessity, appealing prior authorization sections and retro prior authorizations.

* Provide guidance on peer to peer consultations to ensure linkage to treatment

* Ensure offices and pharmacy receive full reimbursement for their service from commercial insurance, Medicare, and Medicaid providers

* Oversee processing billing and dispensing for the Tampa Bay Buccaneers NFL Team.

* Maintain solid and trustworthy relationships with key clinicians and offices.

* Provide medication and therapy education to patients and clinicians

* Planned, directed and monitored all financial, operational, professional, and clinical activities of the pharmacy.

* Completed all Medication Therapy Management opportunities and comprehensive medication reviews given at a monthly basis and attained approved payments for all pending TIPS and CMRs.

* Implemented policies and procedures to ensure pharmacy provides optimal pharmaceutical services which meet all legal, accreditation and certification requirements and standards.

* Screen and review medication orders for accuracy, contraindications, and drug interactions.

* Ensure all pharmacy staff are adequately trained, licensed/certified/registered with all associated continuing education credits.

* Implemented clinical programs designed to promote effective, adequate, and cost -effective drug therapy.

• Assisted in reviewing, dispensing and shipment of prescription medication through the United States
• Counseled patient and on prescription medication in accordance with latest therapeutic guidelines

• Established and maintained peer-peer relationships with leading physicians at major academic institutions and clinics. Served as a scientific expert, educator, and resource within the medical community.

• Provided clinical support to patients with chronic health problems through therapy compliance initiatives.

• Proactively assisted doctor offices in prior authorizations and appeal process with linkage to treatment.

• Collaborated with Hepatologist in recommendation of the most appropriate therapy simultaneous with the patient's genotype in accordance with guidelines set by the Infection Disease Society of America (IDSA) and the American Association for the Study of the Liver Diseases (AASLD).

• Conferred regularly with appropriate staff regarding patient status, provide clinical consultation and information regarding services and therapy management to patients, physician, and other health care professionals

• Coordinated with physicians and other clinicians to establish optimized, appropriate treatment plans in therapeutic disease states especially in fields of Gastroenterology, Hepatology, Dermatology, Rheumatology, Urology, and Infectious Disease

Worked closely with KOLs to educate healthcare providers on the clinical benefits of products and where they fit into practice protocol.

• Presented many high impact presentations.

• Developed strategic scientific content for advisory boards that addressed critical gaps in therapy. Worked with KOLs to ensure delivery of key messages.

• Managed a medical sales training program on products, key data, and efficient delivery of data.

• Sat on product development board. Identified current needs in medical field, worked closely with research team, and oversaw development of new products at many critical levels of approval.

• Utilized competitive intelligence to assess current and future moves, incorporating items into marketing plans and developed strategies to address competitive needs.