Madeline J. Giles
Saint Paul,MN
Summary
Dynamic Clinical Formulary Pharmacist with over 11 years of pharmacy experience, excelling in Medicare formulary management and cost analysis. Proven track record in developing utilization management programs and enhancing formulary performance. Strong communicator and problem solver, dedicated to optimizing drug spend and ensuring regulatory compliance while driving quality improvement initiatives.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Clinical Formulary Pharmacist
UCare
Minneapolis, MN
09.2020 - Current
- Maintained 4 Medicare Part D formularies simultaneously, including monthly CMS submission, annual formulary development and ongoing oversight to ensure accuracy and transparency.
- Completed cost and rebate analysis for both pharmacy and medical drugs to optimize drug spend and determine formulary status and utilization management programs.
- Created and maintained all medical drug utilization management programs for Medicare, Medicaid and Health Exchange plans including both custom step therapy policies and standard policies.
- Developed and maintained automation tools to enhance formulary performance and member experience.
- Identified inappropriate prescribing, duplicate billing and cost-savings opportunities to decrease drug spend with focus on biosimilar medications.
- Reviewed, prepared materials and presented new drug information and new formulary strategies with recommendations for formulary placement at P&T meetings.
- Supported inter-departmental teams to review pharmacy and medical appeals, complete monthly oversight tasks, prepare materials for and participate in audit meetings.
- Participated in the execution of a new PBM implementation including authorization entry oversight, unique benefit set-up design, rebated drug category optimization, and mitigation strategies for identified errors.
Clinical Review Pharmacist
Prime Therapeutics
Eagan, MN
10.2016 - 09.2020
- Performed prior authorization, step therapy, coverage exception and additional clinical reviews for a variety of clients, each applying unique criteria requirements.
- Performed specialized clinical reviews for hemophilia medications as part of a small pharmacist team by performing enhanced outreach to hemophilia treatment centers ensuring patients are receiving the most cost-effective and clinically effective therapies.
- Regularly submitted criteria updates upon identification of gaps in criteria and inconsistencies with reviewing to streamline processes and continually improve the reviewing process.
- Assisted the medication therapy management team by performing smart adherence calls to Medicare Part D members for star-rated medications to identify gaps in therapy and educate patients on the importance of adhering to these medications.
- Mentored new and oncoming clinical pharmacists and those struggling with quality and efficiency to enhance production and provide clinical guidance.
Clinical and Staff Pharmacist
Goodrich Pharmacy
Anoka, MN
07.2014 - 10.2017
- Entered prescription data electronically, filled and verified medications accurately.
- Conducted MTM visits in the HeathPartners Riverway Anoka Clinic and Multicare Associates clinics using a collaborative practice agreement to start, stop, and alter drug therapy.
- Documented using both EPIC and NextGen electronic medical record systems.
- Counseled patients on how to appropriately take medications and what to expect from their medications.
- Precepted pharmacy students and advised the pharmacy resident through clinical topic discussions, immunization delivery, and during MTM visits.
Education
Ambulatory Care Residency Program -
University of Minnesota College of Pharmacy
Anoka, MN07.2014
Doctor of Pharmacy Program -
University of Minnesota College of Pharmacy
Minneapolis, MN05.2013
Bachelor of Arts - Biology
Hamline University
St. Paul, MN05.2009
Skills
- Medicare formulary management
- Communication skills
- Medical drug utilization management
- Problem solving and critical thinking
- Regulatory compliance
- Quality improvement
- Rebate analysis
- Pharmacology expertise
- Cost analysis
Certification
- Pharmacist License, 121312, Minnesota State Board of Pharmacy, 06/13, Present
- BLS Healthcare Provider (CPR and AED), American Heart Association, 10/09, Present
References
Available upon request
Personal Information
Title: Clinical Pharmacist
Timeline
Clinical Formulary Pharmacist
UCare
09.2020 - Current
Clinical Review Pharmacist
Prime Therapeutics
10.2016 - 09.2020
Clinical and Staff Pharmacist
Goodrich Pharmacy
07.2014 - 10.2017
Ambulatory Care Residency Program -
University of Minnesota College of Pharmacy
Doctor of Pharmacy Program -
University of Minnesota College of Pharmacy
Bachelor of Arts - Biology
Hamline University