Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

JENNIFER MCKENNA

Scotch Plains

Summary

Prior Authorization pharmacist prepared for impactful contributions in medication management and approval processes. Skilled in evaluating clinical information and ensuring compliance with regulatory standards. Strong focus on team collaboration and adaptability to changing needs. Reliable and results-driven with expertise in patient care, drug utilization review, and healthcare communication.

Overview

24
24
years of professional experience
1
1
Certification

Work History

Prior Authorization Pharmacist

CapitalRx
11.2023 - Current
  • Make clinical prior authorization determinations for established Medicare clients in accordance with medical necessity and Centers for Medicare & Medicaid Services (CMS) coverage guidelines within established turnaround times.
  • Complete clinical outreach and provide detailed and thorough documentation for prior authorization cases and override approvals.
  • Remain current on all communications and updated processes relayed through varied communication channels and apply to daily processes.
  • Consistently review weekly quality reporting and communicate with audit team where needed to ensure Quality Assurance
  • Identify and communicate ideas for efficiency, process improvement, and enhancement of job aids and resource materials.
  • Support the prior authorization technician team by assisting with ePA case triage and outreach.
  • Review commercial client prior authorization requests (initial/reconsiderations) and complete peer-to-peer reviews with providers as needed.
  • Follow internal Standard Operating Procedures, Policies, Job Aids, Policies, and adhere to Medicare and HIPAA guidelines and policies.
  • Follow established procedures to protect members through safeguards for data integrity, confidentiality, and security of information as required by policies and accreditation organizations.

Lead Bilingual Prior Authorization Pharmacist

Filip, LLC - Pharmacy Benefit Manager
09.2021 - 05.2023
  • Conducted coverage determinations of Prior Authorization (PA), Appeal, and Brand Medically Necessary drug therapy requests in accordance with medical necessity and covered benefit guidelines while maintaining quality and productivity standards.
  • Delivered high-level customer care and service to members, prescribers, and provider inquiries relating to plan coverage, Drug Utilization Review (DUR), and prior authorizations.
  • Collaborated with internal business and clinical partners for client on-boarding and transitions, healthcare, and clinical program initiatives.
  • Active Participant of the Coverage Criteria Council providing clinical feedback on newly created and revised clinical policies.
  • Worked cross functionally with Information Technology, Product Development, and internal departments providing evaluation of multiple disparate systems to identify areas for improvement.
  • Active involvement in FAST Self Service PA Operation Application from exploration phase through full implementation and process flow development.
  • Followed all internal Standard Operating Procedures (SOPs), aided in maintenance of PA team SOPs, and adhered to HIPAA guidelines and policies.
  • Actively supported clinical and concierge team staff training, education, and development.
  • Provided bilingual support to members and providers including the creation of written communication of prior authorization outcomes.

Clinical Pharmacist, Specialty

CVS Health
11.2008 - 09.2021
  • Collaborated with the Product Development team in an Electronic Health Record (EHR) pilot through clinical assessment of medical data utilizing the Data Viewer application for the identification of clinical interventions across multiple therapy areas.
  • Provided clinical resolution, personalized patient support services, DUR, drug information for complex health conditions in the areas of Chemotherapy, MS, RA, Psoriasis, Viral Hepatitis, GH Deficiency, etc.
  • Completed Adverse Event monitoring and reporting for all supported Specialty site locations.
  • Identified process improvement strategies to enhance member services.
  • Worked closely with professional practice to meet accreditation requirements for JCAHO, URAC, and ACHC.
  • Conducted Medication Therapy Management (MTM) Outreach, utilizing MirixaPro, completed an interactive Comprehensive Medication Review for the identification of potential medication-related problems such as care gaps related to therapy omissions, adherence issues, possible side effects and drug interactions for the improvement of patient healthcare outcomes.
  • Managed the Humira/Enbrel Compliance & Persistency Program, assuring positive patient therapeutic outcomes by assessing therapy compliance and effectiveness.
  • Trained newly hired Pharmacists and Pharmacy technicians and provided ongoing support.
  • Provided bilingual patient support to educate members, increase patient comfort, and raise patient satisfaction scores.

Senior Drug Information Specialist

Schering-Plough Corporation
01.2002 - 11.2004
  • Managed and provided resolution to all consumer and healthcare professional inquiries relating to the therapeutic areas of Anti-Infectives.
  • Complied with FDA regulations and Schering-Plough policies and procedures; supporting Adverse Event and product quality processes.
  • Provided exemplary customer service by channeling and communicating to other Schering-Plough functional areas such as Marketing, Medical Affairs, Drug Safety, Product Quality, Regulatory, and Sales departments.
  • Researched and prepared written/verbal responses to medical information requests from healthcare professionals regarding Schering-Plough marketed products.
  • Maintained the Anti-Infective Drug Information Services standard letter database.
  • Supported Marketing Department endeavors requiring Drug and Medical Information.
  • Attended medical conferences relating to the field of Hepatology to identify pertinent information from clinical trials relating to Schering-Plough products.
  • Effectively worked on a team to maintain cutting edge knowledge on product, medical, and disease information; communicated across the department regarding customer calls, trends, programs, and solutions.
  • Mentored and provided training for call center specialists and graduate interns.

Education

Bachelor's Degree - Pharmacy

Philadelphia College of Pharmacy and Science
01.1998

Skills

  • 3 years Prior Authorization experience
  • Excellent Verbal/Written Communication
  • Organizational Skills
  • Microsoft Office
  • Pharmacy workflow optimization
  • Interprofessional collaboration
  • Clinical documentation
  • Drug utilization review

Certification

  • NJ Pharmacy License: 28RI02610500
  • FL Pharmacy License: PS35492

Languages

Spanish
Native or Bilingual

Timeline

Prior Authorization Pharmacist

CapitalRx
11.2023 - Current

Lead Bilingual Prior Authorization Pharmacist

Filip, LLC - Pharmacy Benefit Manager
09.2021 - 05.2023

Clinical Pharmacist, Specialty

CVS Health
11.2008 - 09.2021

Senior Drug Information Specialist

Schering-Plough Corporation
01.2002 - 11.2004

Bachelor's Degree - Pharmacy

Philadelphia College of Pharmacy and Science

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