María Karla Casals, PharmD, BCPS, MBA
Senior Clinical Pharmacist
Miami,FL
Summary
Clinical Pharmacist and healthcare leader with extensive experience in utilization management, grievances and appeals, oncology pharmacy, and regulatory compliance across Medicare, Medicaid, and commercial lines of business. Proven expertise in quality assurance, policy development, operational leadership, and cross-functional collaboration. Committed to advancing patient care while driving organizational excellence.
Overview
10
10
years of professional experience
4
4
Certifications
2
2
Languages
Work History
Senior Clinical Pharmacist
CarelonRx – Elevance Health
10.2020 - Current
- Develop and perform quality checks for grievance and appeal reports across Medicare, Medicaid, and commercial business lines.
- Oversee clinical pharmacy operations for the Grievances and Appeals department.
- Develop, implement, and maintain policies, procedures, and departmental workflows.
- Ensure compliance with CMS regulations, NCQA and URAC standards, performance improvement initiatives, audits, and accreditation standards.
- Achieved 100% compliance with NCQA, URAC and CMS Data Validation Audits by completing all audits with accuracy and efficiency.
- Train and mentor pharmacists and pharmacy technicians.
- Coordinate system implementation of services for new clients.
- In charge of delivering monthly, quarterly and annual quality and production reports for 23 clients.
- Lead team of 22 people in the development of California External Exceptions Reviews - EERR Project.
- Supervised team of 6 staff members including techinicians and a pharmacist.
- Lead team of 22 people in the development of california External Exceptions Reviews - EERR Project.
Oncology Clinical Pharmacist
Baptist Health of South Florida
05.2017 - Current
- Review and validate chemotherapy treatment protocols, including cycles, dates, and clinical parameters.
- Verify preparation of hazardous and non-hazardous IV medications.
- Communicate with physicians to optimize supportive therapy.
- Develop institutional policies for chemotherapy dosing and drug interchange.
Clinical Pharmacist
CarelonRx – Elevance Health
08.2018 - 10.2020
- Conducted 110+ prior authorization reviews daily in compliance with Medicare and Medicaid guidelines.
- Maintained quality review performance above 98%.
- Reviewed Medicare and Medicaid appeals.
- Collaborated with engineers to enhance the prior authorization operating system.
Clinical Pharmacist
Coral Gables Hospital
07.2016 - 08.2018
- Clarified medication orders and ensured formulary compliance.
- Optimized medication therapy to improve patient outcomes.
- Participated in quality improvement initiatives focused on patient safety.
Education
Master of Business Administration (MBA) - Healthcare Executive
University of Miami
Miami, FL11.2025
Doctor of Pharmacy (PharmD) - undefined
Nova Southeastern University
Davie, FL05.2015
Associate of Arts - Biology
Miami Dade College
Miami, FL04.2011
Skills
Drug utilization review
Management of pharmacy operations
System enhancement
Regulatory framework design
Certification
Board-Certified Pharmacotherapy Specialist (BCPS)
Timeline
Senior Clinical Pharmacist
CarelonRx – Elevance Health
10.2020 - Current
Clinical Pharmacist
CarelonRx – Elevance Health
08.2018 - 10.2020
Oncology Clinical Pharmacist
Baptist Health of South Florida
05.2017 - Current
Clinical Pharmacist
Coral Gables Hospital
07.2016 - 08.2018
Doctor of Pharmacy (PharmD) - undefined
Nova Southeastern University
Master of Business Administration (MBA) - Healthcare Executive
University of Miami
Associate of Arts - Biology
Miami Dade College
AWARDS
Go Above Recognition (Multiple Awards: 2020–2025)