LaTarshia Boone
Roanoke Rapids,NC
Summary
Dynamic Clinical Pharmacist with extensive experience at ANTHEM Health Services, excelling in medication therapy management and regulatory compliance. Proven track record in conducting clinical reviews and enhancing patient education, ensuring optimal medication safety. Adept at problem-solving and effective communication, driving improvements in drug utilization and patient outcomes.
Overview
25
25
years of professional experience
Work History
Clinical Pharmacist
Conduent State Healthcare
Elkridge, MD (remote)
04.2024 - Current
- Conducts peer-to-peer reviews with physicians who disagree with denial decisions.
- Utilizes client-specific regulations to perform clinical reviews and assessments.
- Provides support to ancillary providers (physicians, nurses, network pharmacists, etc.) as required.
- Performs a clinical review of initial coverage determinations on non-preferred, cost-exceeds-maximum, step-therapy requests, using client-specific guidelines.
- Assesses member compliance with the plan through direct contact with their physicians or care team.
Clinical Pharmacist
ANTHEM Health Services
Norfolk, Virginia (remote)
12.2014 - 03.2024
- Provided evaluation of member Rx needs and therapies through review of medication history to determine if medications were appropriate.
- Assessed member compliance with the plan through direct contact with members and their physicians.
- Ensured that members understood the appropriate use of current prescriptions.
- Reviewed medications with physicians when therapies did not meet national standards, and counseled physicians about alternative medications.
- Served as a resource to the clinical team in disease management, and other clinical areas. ∙
- Performed clinical review of initial coverage determinations and reconsiderations (appeals) on Non-Formulary, Prior Authorization, Quantity Limit, and Step Therapy requests using client-specific guidelines
- Provided support to ancillary providers (physicians, nurses, network pharmacists, etc.) as required
- ∙Utilized client-specific regulations to perform clinical reviews and assessments ∙
- Collaborated with Medical Directors for peer-to-peer reviews as needed
- Conducted peer-to-peer reviews with physicians who disagreed with denial decisions
Clinical Pharmacist
CVS/caremark
Raleigh, NC
01.2012 - 12.2014
- Performed clinical review of initial coverage determinations and re-determinations (appeals) on Non-Formulary, Prior Authorization, Quantity Limit, Step Therapy, and Tier Exception requests using guidelines developed by the Pharmacy and Therapeutics (P&T) Committee
- Provided support to ancillary providers (physicians, nurses, network pharmacists, etc.) as required ∙
- Performed supervisory responsibilities of Clinical Services staff and workflow as assigned by the Manager of Clinical Services
- Utilized Medicare Part D and CMS regulations to perform clinical reviews and assessments.
MTM Pharmacist
Humana
Louisville, Kentucky (remote)
06.2008 - 08.2010
- Provided medication therapy management (MTM) to eligible members through one-on-one telephonic consultations.
- Served as a trusted advisor to members.
- Performed comprehensive medication reviews
- Applied clinical knowledge to resolve medication-related problems.
- Ensured optimal medication safety
- Collaborated and engaged in discussions with other health care professionals to provide complete pharmaceutical care and therapy management
Director of Pharmacy/MTM Pharmacist/Clinical Account Manager
ACS Xerox
Atlanta, GA/Raleigh, NC
08.2000 - 05.2008
- Performed telephonic Medication Therapy Management (MTM) consultations addressing education, adherence, cost savings opportunities and safety with patients and providers ∙
- Reviewed drug prior authorization requests as needed by client and/or support staff ∙
- Reviewed and updated tables required for correct claims adjudication
- Advised appropriate client representative(s) and the Drug Utilization Review (DUR) Board as determined and requested by the client on pharmacy drug utilization review (DUR) issues.
- Provided clinical direction and consultation to a variety of client types including Medicaid, HMO Employer Group, Workers' compensation, and others
- Assisted in the development of the formulary and drug benefit design.
- Performed utilization reviews of client utilization trends and provided solutions to ensure appropriate utilization from both quality-of-care and cost-efficient perspectives.
- Conducted and/or participated in the client's DUR, P&T Committee meetings, or other meetings to present pharmacy and clinical information required or requested by the client.
- Participated in the development of internal clinical programs.
- Assisted in the procurement of new business as required.
- Proactively presented clients with solutions to potential areas for clinical or cost concerns.
- Managed daily operations for direct report pharmacists.
Education
Doctor of Pharmacy -
Mercer University
Atlanta, GASkills
- Clinical review
- Medication therapy management
- Regulatory compliance
- Prior authorization
- Drug utilization review
- Patient education
- Medication safety
- Clinical documentation
- Problem solving
- Effective communication
References
References available upon request.
Timeline
Clinical Pharmacist
Conduent State Healthcare
04.2024 - Current
Clinical Pharmacist
ANTHEM Health Services
12.2014 - 03.2024
Clinical Pharmacist
CVS/caremark
01.2012 - 12.2014
MTM Pharmacist
Humana
06.2008 - 08.2010
Director of Pharmacy/MTM Pharmacist/Clinical Account Manager
ACS Xerox
08.2000 - 05.2008
Doctor of Pharmacy -
Mercer University