Jill Lofton
Ruston,LA
Summary
Experienced pharmacist with a focus on Medicare medical policy, formulary management, and regulatory compliance. Skilled in conducting prior authorizations, optimizing patient care, and leading audit preparation efforts. Reliable and collaborative, committed to advancing healthcare quality through rigorous adherence to clinical standards and best practices.
Overview
20
20
years of professional experience
Work History
Clinical Pharmacist
LA Blue
01.2023 - Current
- Oversight of Pharmacy Benefit Manager (PBM) activities and formulary management.
- Conduct CMS Overutilization Monitoring System (OMS) reviews to assess medication compliance and identify potential misuse.
- Lead for implementation and maintenance of Medicare medical drug policies while working to implement step therapy process.
- Part of the Medicare medical rebate team, focusing on optimizing financial outcomes and cost savings.
- Provide customer service support for pharmacy-related inquiries and grievances.
Supervisor, Pharmacy Prior Authorizations
Vantage Health Plan, Inc.
11.2012 - 12.2022
- Enhanced patient outcomes by streamlining the review and processing of prior authorization requests.
- Ensured adherence to federal and state pharmaceutical regulations, fostering a culture of compliance.
- Led pharmacy preparation efforts for CMS and NCQA audits, ensuring regulatory compliance.
- Developed training materials to improve staff knowledge of prior authorization policies and procedures.
- Improved customer satisfaction through prompt and accurate handling of medication approvals.
Relief Pharmacist
Affinity Health Group
07.2012 - 11.2012
- Dispensed and verified patient prescription orders, conducting necessary utilization reviews.
- Collaborated with healthcare professionals to optimize patient care and ensure medication safety.
- Provided exceptional customer service while maintaining patient confidentiality in accordance with HIPAA regulations.
- Participated in continuing education programs to stay up-to-date with industry developments and maintain professional licensure requirements.
Staff Pharmacist
Legends Pharmacy
05.2009 - 11.2012
- Checked prescriptions for appropriate dosage, drug interactions, allergies and contra-indications before dispensing medications.
- Effectively resolved insurance rejections and other billing issues.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Coordinated pharmacy staff schedule, home delivery, and nursing home delivery schedules.
- Utilized unit dose packaging (e.g., Doc-U-Dose, blister packaging) to improve patient compliance.
Pharmacist-in-charge (PIC) Long Term Care Pharmacy
Healthcare Warehouse Pharmacy
10.2004 - 05.2009
- Managed a team of pharmacy technicians, providing guidance and training to ensure adherence to best practices and regulatory compliance.
- Monitored controlled substances inventory and records, ensuring compliance with state regulations and preventing diversion or misuse.
- Dispensed and verified patient prescription orders, conducting necessary utilization reviews.
- Managed drug and supply inventories.
Education
Bachelor of Science - Pharmacy
University of Louisiana Monroe
Monroe, LA12-1993
Skills
- Medicare Prescription Drug Plans
- Drug Formulary Management
- Drug Utilization Review
- Prior Authorizations
- Medical Policy
- Medication Safety
- Confidentiality and HIPAA
- Patient Education and Counseling
- Multitasking
- Time management abilities
Licenses
PST.015556 Pharmacist, Louisiana
PD12465 Pharmacist, Arkansas
Timeline
Clinical Pharmacist
LA Blue
01.2023 - Current
Supervisor, Pharmacy Prior Authorizations
Vantage Health Plan, Inc.
11.2012 - 12.2022
Relief Pharmacist
Affinity Health Group
07.2012 - 11.2012
Staff Pharmacist
Legends Pharmacy
05.2009 - 11.2012
Pharmacist-in-charge (PIC) Long Term Care Pharmacy
Healthcare Warehouse Pharmacy
10.2004 - 05.2009
Bachelor of Science - Pharmacy
University of Louisiana Monroe