LOREDANA AGBOR

• Review Prior Authorization and Appeals requests for Medicare clients, rendering determinations based on CMS guidelines and established clinical criteria.
• Ensure all decisions are accurately documented and meet regulatory requirements.
• Collaborate with Medical Directors to overturn or uphold Prior Authorization cases.

• Prepare and administer vaccines (APHA Certified Immunizer).
• Provide Medication Therapy Management (MTM) services to optimize medication use and reduce the risk of adverse events.
• Provide prior authorization services (work with Doctors and patients)
• Analyze prescribing trends to monitor patient compliance to prevent excessive usage or harmful interactions.
• Dispense and review prescriptions to ensure accuracy, compliance with professional state and federal regulatory requirements.
• Collaborate with other healthcare professionals to monitor, review, and evaluate patient effectiveness.
• Educate patients on medication use, storage, and side effects.
• Solicit information from patients regarding past and current medication to prevent drug interactions.
• Recruiting, training, and managing staff.

• Processed Prior Authorization requests/cases for insurance coverage of formulary and non-formulary drugs that reject at the dispensing pharmacy.

• Worked on appeal cases (after Prior Authorization denials) rendering decisions based on guideline criteria and clinical evidence.

• Worked in collaboration with Medical Directors to overturn or uphold Prior Authorization cases.

Same responsibilities as Walgreens

Same responsibilities as Walgreens

• Same responsibilities as Walgreens