Jacqueline Cruz
San Bernardino,CA
Summary
Dedicated Pharmacy Technician with over 12 years of experience in pharmacy operations and analysis within managed care and retail environments, specializing in Medi-Cal and Medicare populations. Proven ability to analyze complex data, identify operational efficiencies, and ensure regulatory compliance. Bilingual in English and Spanish, skilled in enhancing communication with diverse patient populations and fostering collaborative relationships with stakeholders.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Pharmacy Audit Analyst
OPTUM RX
Irvine, CA
06.2018 - Current
- Manage claims operations issue management and audit functions by monitoring and analyzing pharmacy claims data for accuracy and compliance, supporting financial reporting and addressing discrepancies
- Collaborate with Pharmacy Benefit Managers (PBM), consultants, and healthcare providers to align audit findings with operational strategies, ensuring compliance with regulatory standards
- Drive quality improvement initiatives by developing comprehensive audit and compliance reports, identifying process improvement opportunities, and reporting potential fraud and abuse
Clinical Pharmacy Program Coordinator
IEHP
Rancho Cucamonga, CA
07.2016 - 06.2018
- Led initiatives related to pharmacy benefits, including the execution of clinical programs and regulatory compliance, coordinating efforts with internal and external stakeholders
- Conducted data analysis to inform clinical outcomes and program effectiveness, actively supporting D-SNP leadership and Pharmacy Services Director in developing strategies for program enhancement
- Developed and reviewed regulatory reports, standardizing clinical review processes to ensure adherence to quality and regulatory requirements
Pharmacy Services Specialist
ALIGNMENT HEALTHCARE
Orange, CA
03.2015 - 07.2016
- Delivered exceptional service in a high-volume pharmacy call center environment, navigating complex provider pharmacy issues and ensuring timely resolution of claims disputes
- Fostered effective communication with member services to resolve pharmacy-related member complaints and improve overall satisfaction within the pharmacy authorization process
- Collaborated with stakeholders to enhance operational efficiency and patient access to pharmaceutical services
Pharmacy Technician
CVS PHARMACY
San Bernardino, CA
05.2012 - 03.2015
- Assisted pharmacists in accurately filling prescriptions and managing inventory levels, ensuring compliance and efficiency in daily operations
- Engaged with patients through proactive outreach to ensure adherence to medication regimens, contributing to improved health outcomes
Education
Bachelor of Science - Psychology
Capella University
Minneapolis, MNAssociate of Arts - Liberal Arts - Social and Behavioral Sciences
San Bernardino Valley College
San Bernardino, CACertificate - Pharmacy Technician
United Education Institute
San Bernardino, CASkills
- Pharmacy Benefit Management (PBM)
- Data Analysis & Reporting
- Regulatory Compliance (CMS, NCQA)
- Quality Improvement Initiatives
- Project Management & Coordination
- Claims Operations and Adjudication
- Training and Mentorship
- Cross-Functional Team Collaboration
- Advanced Microsoft Office Skills (Excel, Access, Word, PowerPoint)
Certification
- Pharmacy Technician License, CA, PT License #118018
- PTCB Certification, #10070480
Languages
- English, Native/Bilingual
- Spanish, Native/Bilingual
Timeline
Pharmacy Audit Analyst
OPTUM RX
06.2018 - Current
Clinical Pharmacy Program Coordinator
IEHP
07.2016 - 06.2018
Pharmacy Services Specialist
ALIGNMENT HEALTHCARE
03.2015 - 07.2016
Pharmacy Technician
CVS PHARMACY
05.2012 - 03.2015
Bachelor of Science - Psychology
Capella University
Associate of Arts - Liberal Arts - Social and Behavioral Sciences
San Bernardino Valley College
Certificate - Pharmacy Technician
United Education Institute