Jennifer Miszuk
Cave Creek,USA
Summary
Dedicated pharmacist skilled in clinical assessments and medication management within specialty and managed care settings. Expertise in analyzing drug therapies and clinical data to optimize patient-specific treatment plans and improve health outcomes and operational efficiency. Strong leadership capabilities demonstrated through mentoring and training pharmacy personnel to enhance service delivery.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Clinical Pharmacist
Devoted Health
Boston, MA
10.2024 - Current
- Performed medical necessity review of prior authorization requests in accordance to clinical policies and member benefit coverage for Medicare Part B beneficiaries
- Clinical review of outpatient drugs for parenteral administration for adult and pediatric use in the following disease states: oncology and supportive care, nephrology, rheumatology, neurology, infectious disease, and ophthalmology
Clinical Pharmacist
Centene Corporation
Tempe, AZ
01.2022 - 10.2024
- Performed medical necessity review of prior authorization requests in accordance to clinical policies and member benefit coverage for Medicare and Medicaid Part B beneficiaries
- Conducted peer-to-peer consultations with prescribing providers for secondary review of clinical determinations
- Reviewed clinical appropriateness of oncologist-recommended clinical determinations in accordance with established treatment regimens in NCCN compendia
- Knowledgeable of appropriate biosimilar use for healthcare cost-saving initiatives
- Ability to analyze clinical compendia and high-quality research studies to adhere appropriate off-label and pediatric use
- Ability to analyze medical records, radiological imaging, and appropriate laboratory values to evaluate clinical response to drug treatment regimen
- Facilitated technician training sessions to augment their clinical knowledge of covered drugs, associated disease states, and their ability to interpret clinical information in accordance to clinical policies
- Exceeded production standards and recipient of multiple monthly Quality 100 Awards
Clinical Pharmacist
Total Med, Contractor for United Health Group (OptumRx)
Phoenix, AZ
08.2021 - 12.2021
- Performed medical necessity review of prior authorization requests in accordance to clinical policies and member benefit coverage for Medicare and Medicaid Part D beneficiaries and specialty drugs
- Conducted clinical review for specialty and pharmaceutical drugs including: step-therapy, non-formulary, tier cost, opioid management, quantity limits, and compounded drug requests
- Collaborated with requesting providers to verify accuracy of requests and obtain pertinent clinical information to support patient-specific drug therapy plans
- Knowledgeable of pharmacy benefit formularies and ability to recommend alternatives specific to member needs
- Manually edited pharmacy adjudication software for proper drug utilization review and claim adjudication
Clinical Pharmacist
Randstad Healthcare, Contractor for United Health Group (OptumRx)
Phoenix, AZ
03.2021 - 06.2021
- Conducted telephonic Medication Therapy Management (MTM) consultations to optimize therapeutic outcomes
- Performed comprehensive reviews of patient-specific drug treatment plans for clinical appropriateness and to identify duplicate therapy, drug interactions, adverse effects, and inappropriate drug selection, dosing, and/or administration
- Provided clinical recommendations for medication therapy gaps based on established disease state guidelines
- Assessed medication adherence and used motivational interviewing skills to enhance compliance
- Ability to efficiently resolve conflict and uphold superior customer service skills in a call center environment
Staff Pharmacist
CVS Health
Scottsdale, AZ
12.2020 - 02.2021
- Managed a high-volume retail pharmacy store including direct supervision of all pharmacy staff members, interns, production, inventory, and records in accordance with corporate company policies and all federal and state regulations
- Verified prescription accuracy, transferred and dispensed prescription drugs, administered vaccinations according to CDC guidelines, collaborated with physicians on drug therapy plans, and maintained prescription records
- Provided meticulous management of controlled substances including inventory, storage, dispensing, records
- Performed Drug Utilization Review and Medication Therapy Management to maintain accurate medical profiles, ensure patient safety, and provide clinical recommendations to optimize patient-specific treatment plans
- Counseled patients on safe and effective use of prescriptions, over the counter medications, and vaccinations
Instructional Designer
Molina Healthcare, Inc.
Long Beach, CA
02.2009 - 08.2014
- Lead instructional designer and project manager for the development of training solutions to achieve corporate expansion initiatives for acquisition of new state-specific Medicaid health plans
- Assisted Management with process improvement initiatives, conflict resolution, and candidate interviews
- Facilitated large-group project meetings and collaborated with interdisciplinary team members to strategize resources for product development within established timeframes
- Mentored team members via individual and group meetings to enhance quality control and support personal development goals for other team members by providing education and performance opportunities
- Technical Writer for development of Standard Operating Procedures (SOPs), Workflows, and Job Aids
- Completed certification programs: 'Total Trainer' and 'Designing and Facilitating Effective Trainings'
- Well-organized, meticulous, and analytical individual with strong problem-solving, leadership and interpersonal skills
Quality Analyst
CVS Health
Scottsdale, AZ
05.2007 - 02.2009
- Verification of prescription claim financial adjustments for Medicare Part D beneficiaries to ensure accurate claim payment and exceed PBM quality measures
- Analyzed prescription claims to determine financial responsibility according to cost-sharing guidelines established by Centers for Medicare and Medicaid (CMS), Health Plan, pharmacy network contracts, and drug formularies
- Identified claim discrepancy patterns, recognized software configuration errors, and educated team members on new procedures through large-group trainings and SOP development
- Possessed knowledge of PBM drug formularies and mail order pharmacy practices
- Led Quality Process Improvement Team and co-developed Quality New Hire Mentoring program to enhance onboarding experience
- Developed presentations for internal and external auditors, demonstrating departmental compliance with policies
- Recipient of the following departmental awards: Quality Team 'Most Valuable Player (MVP)', 'Going Above and Beyond', and 'Advanced Medicare Technician'
- Knowledgeable of PBM organization, CMS programs and regulations, Health Plan benefit guidelines, and PBM processes for reducing drug cost and improving quality patient care
Education
Doctor of Pharmacy -
Midwestern University
Glendale, AZ05-2020
Master of Arts - Biomedical Sciences
Midwestern University
Glendale, AZ05-2016
Master of Education - Curriculum and Instruction
Arizona State University
Tempe, AZ05-2007
Bachelor of Science - Biological Sciences
Arizona State University
Tempe, AZ05-2006
Skills
- Prior authorizations
- Specialty pharmacy
- Immunization certification
- Clinical toxicology
- Clinical research
- Drug utilization review
- Medication therapy management
- Pharmacy operations
- Patient education
- Leadership and management
- Critical thinking
- Organizational skills
- Presentation and training
- Technical writing
Certification
- Registered Pharmacist (RPh), Arizona State Board of Pharmacy
- ASHP Certification in Specialty Pharmacy: Hematology and Oncology
- Immunization Certification, Arizona Pharmacy Association (AzPA)
- Basic Life Support (BLS) Provider, American Heart Association (AHA)
- Lawroom – Interviewing Candidates and Terminating Employees, Midwestern University
Clinical Rotations
- Dignity Health, Phoenix, AZ, Clinical Research in Infectious Disease, Collected retrospective data from medical records for a clinical study investigating infectious disease complications in lung transplants recipients., Knowledgeable of drugs used in transplant recipients., Knowledgeable of the various clinical research studies, design methods, statistical analysis, and applications.
- Banner Poison and Drug Information Center, Phoenix, AZ, Toxicology, Knowledgeable of the pathophysiology and therapeutic treatments for acute and chronic clinical presentations of toxicological exposures and envenomations., Participated in Poison Control phone calls from the public or other healthcare professionals regarding therapeutic treatment and/or education for accidental or intentional toxic exposures in adults and children., Shadowed Intensive Care Unit (ICU) Toxicologists and Residents during patient diagnosis and treatment.
- Avella Specialty Pharmacy, Phoenix, AZ, Ambulatory Care – Specialty Pharmacy, Conducted telepharmacy consultations for patients taking specialty drugs for oncology or other rare diseases to discuss drug regimens, adverse events, treatment options, compliance, and monitoring., Completed Prior Authorizations for preceptors by researching clinical data to provide medical evidence supporting a specific drug regimen for the patient., Collected patient data for reporting adverse effects and submit data to physician and manufacturers., Knowledgeable of specialty drugs, distribution, cost, adverse effects, monitoring parameters, use in specific disease states, and compounding.
- HonorHealth – Thompson Peak Hospital, Scottsdale, AZ, Advanced Acute Care, Attended daily ICU rounds with interdisciplinary hospital staff and discussed pathophysiology and treatment protocols for various acute care disease states., Provided patient education to patients upon hospital discharge., Assisted pharmacy technicians with sterile IV compounding.
Timeline
Clinical Pharmacist
Devoted Health
10.2024 - Current
Clinical Pharmacist
Centene Corporation
01.2022 - 10.2024
Clinical Pharmacist
Total Med, Contractor for United Health Group (OptumRx)
08.2021 - 12.2021
Clinical Pharmacist
Randstad Healthcare, Contractor for United Health Group (OptumRx)
03.2021 - 06.2021
Staff Pharmacist
CVS Health
12.2020 - 02.2021
Instructional Designer
Molina Healthcare, Inc.
02.2009 - 08.2014
Quality Analyst
CVS Health
05.2007 - 02.2009
Doctor of Pharmacy -
Midwestern University
Master of Arts - Biomedical Sciences
Midwestern University
Master of Education - Curriculum and Instruction
Arizona State University
Bachelor of Science - Biological Sciences
Arizona State University