Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Kristyn Boccia

Campbell Hall,NY

Summary

Experienced and driven licensed Pharmacist with proven experience in leadership and utilization management roles providing optimal levels of patient care to a diverse client base. Conscientious quality oriented Clinical Pharmacist known for high productivity and efficient task completion. Specialized in prior authorization reviews and medication therapy management. Excel at communication, teamwork, and problem-solving to ensure optimal patient care, outcomes and support healthcare team objectives. Adhere to regulatory guidelines, drug utilization review, and professional standards and practices.

Overview

15
15
years of professional experience
1
1
Certification

Work History

Clinical Pharmacist-Utilization Management

Centene Pharmacy Services
Long Island City, NY
04.2018 - Current
  • Handle prior authorization reviews for Medicare Part D, Medicare Part B and Commerical Plans
  • Followed plan formulary criteria for off-label, non-formulary, step therapy, quantity limit and prior authorization processes
  • Made clinically sound and confident decisions on cases based on clinical guidelines and professional judgement
  • Determine appropriateness of requests based on UM criteria, Medicare/CMS criteria and Centene guidelines
  • Utilized CMS approved literature for appropriateness of diagnosis and medication use by using micromedex and AHFS Drug Information by PEPID
  • Provided clinical knowledge to physicians over the phone pertaining to questions and interpretations of clinical guideline criteria and coverage determinations rendered
  • Facets, Caremark and MedHOK system experience
  • Coordinate with case managers regarding medication reconciliation requests for high risk members as well as conduct transition of care reviews for members recently discharged from a hospital
  • Conduct peer to peer reviews with providers
  • Process redetermination requests for denied cases
  • Submit recommendations for denial to the medical director
  • Perform medical billing including HCPCS (Jcode) reviews
  • Utilized local and national coverage determination guidelines to determine the medical necessity of a medical service

Supervising Pharmacist

Emblem Health
Brooklyn, NY
11.2014 - 03.2018
  • Provide stellar customer care while dispensing medications and informing patients about prescriptions
  • Compile and manage patient information to meet confidentiality requirements and screen for drug allergies and interactions
  • Perform drug utilization reviews; analyze prescription trends, monitor patient compliance, and create reports to track and manage excessive usage
  • Train and mentor new team members; supervise all staff in policies and procedures
  • Manage inventory, control and monitor stock items, and review expiration dates to maintain quality control
  • Respond to patient and physician requests in a timely manner and to maintain positive relationships
  • Remain current on drug legislation in order to provide competent pharmacy services to a diverse and large patient population
  • Developed strong professional relationships with physicians and other health care professionals in order to provide the best possible care for our patients
  • Contributed to the development of adherence/compliance tools (refill list and home delivery) for Emblem Health corporate pharmacies to help with star ratings and general adherence to their medications
  • Communicate with physicians and insurance companies
  • Deliver services aligned with physician care/treatment plans
  • Support bottom-line success of pharmacy while delivering optimal levels of patient/ client service

Supervising Pharmacist

Community Care RX
Jamaica, New York
01.2014 - 11.2014
  • Manage specialty pharmacy serving long-term care facilities and providing specialty medications for HIV+ patient population and patients suffering from chronic disabilities
  • Accept, review, and prepare prescriptions for dispensing to patients to meet guidelines and regulations for accuracy and industry compliance
  • Provide advice and information to patients on storage, side effects, dosage, and pharmaceutical drug interactions
  • Complete drug utilization reviews
  • Maintain patient database with confidential profiles
  • Mix, package, and label pharmaceuticals as per legal and industry standards for quality control and drug safety
  • Work with facilities on dispensing blister cards on a daily basis
  • Mix, package, and label pharmaceutical as per legal and industry standards for quality control and drug safety
  • Support patients and physicians to handle adverse events associated with HIV and chronic illness medications by providing accurate and accessible patient-focused drug information
  • Managed the work flow of the pharmacy's daily operations
  • Verified contents and accuracy of labels and packaging for all orders
  • Specialty billing of durable medical equipment (DME) products for eligible patients
  • Worked closely with nurses and other care takers who aid in the patients care
  • Maintain patient database with confidential profiles
  • Train and mentor new team members; supervise all staff in policies and procedures
  • Retain proper inventory control by monitoring stock levels to ensure sufficient drug supplies and expiration dates to ensure quality control

Pharmacist

CVS Pharmacy
Queens, NY
08.2009 - 01.2014
  • Ensured accuracy of prescriptions, provided advice to patients, performed drug utilization review, and managed patient data while handling comprehensive prescription receipt, review, preparation, and dispensing process
  • Educated patients on drug interactions, side effects, dosage, and proper medication storage
  • Adhered to quality control guidelines for mixing, packaging, and labeling pharmaceuticals to meet company policies and legal requirements
  • Handled insurance claims adjudication and reviewed reimbursements; adjusted invoices / claims to meet revenue guidelines
  • Receive and verify prescriptions; dispense medications to adhere to physician orders and authorization as aligned with industry and regulatory standards (federal, state, local)
  • Deliver services aligned with physician care/treatment plans
  • Managed inventory control procedures; monitored stock levels to meet drug supply requirements and reviewed expiration dates for quality control and waste reduction
  • Provide stellar customer care while dispensing medications and informing patients about prescriptions and educate on side effects and medication interactions
  • Compile and manage patient information to meet confidentiality requirements and screen for drug allergies and interactions
  • Responsible for improving Key Performance Measures (KPMs) to maintain excellent status

Education

Doctor of Pharmacy -

ST. JOHNS UNIVERSITY
Jamaica, NY
01.2009

Skills

  • Prior Authorization Review
  • Leadership and communication
  • Training and mentoring
  • Regulatory compliance
  • Attention to detail and accuracy
  • Medication Therapy Management
  • Patient care optimization
  • Team player with a positive attitude
  • Passion for learning and growing skills
  • Patient service and clinical care

Certification

  • NYS Pharmacist License #053825
  • Indiana Pharmacist License #26030997A
  • CPR Certified
  • Certified NYS Immunizer

Timeline

Clinical Pharmacist-Utilization Management

Centene Pharmacy Services
04.2018 - Current

Supervising Pharmacist

Emblem Health
11.2014 - 03.2018

Supervising Pharmacist

Community Care RX
01.2014 - 11.2014

Pharmacist

CVS Pharmacy
08.2009 - 01.2014

Doctor of Pharmacy -

ST. JOHNS UNIVERSITY

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Kristyn Boccia