Mayra Gomez
Victorville,CA
Summary
A highly motivated and experienced leader with a proven track record in managing teams. Organized and dependable at managing multiple priorities with a positive attitude. Ability to handle multiple projects simultaneously with a high degree of accuracy. Seeking challenges or opportunities that foster ongoing leadership development and professional growth, while also providing a platform to apply past experiences and acquired knowledge to enhance healthcare and optimize health.
Overview
24
24
years of professional experience
Work History
Senior Pharmacy Medication Management Specialist
Inland Empire Health Plan
01.2021 - Current
- Ensure quality and compliance issues are addressed in a timely manner
- Develop and maintain training materials, standard work, job aids, desk top references and workflow diagrams.
- Address team members questions related to clinical criteria, standard work, job aids and desk top references related to Medication Management.
- Provide training to on boarding team members and periodical retraining of current team members.
- Ensuring all team members are cross trained to flex based on need.
- Ensure privacy and security of PHI as outlined in IEHP's policies and procedures relating to HIPAA compliance
- Work hand in hand with Clinical Pharmacist with review of Member's medication regimen and assist in care coordination.
- Assist Supervisor with monitoring team members performance, productivity, efficiency grid and develop improvement plans.
- Collaborate interdepartmentally to establish effective communication and workflows that leverage process efficiently.
- Utilize LEAN fundamental techniques to manage process improvement projects that meet both internal and external expectations.
- Retrospectively review teams call interactions with Members and coach accordingly.
- Provide excellent customer service during calls with both Members and providers.
- Navigate electronic medical records and MedHok Prominence to obtain discharge summaries that aid in medication reconciliations.
- Assist Clinical Pharmacist with review of Daily Inpatient Census report to optimize members medication regimen.
- Ensure that PBM is paying claims properly related to COB billing, outreach to pharmacies to coordinate adjudication.
- Participated in rapid improvement event which aided in the integration of Medication Reconciliation into Enhanced Care Management.
- Navigate multiple systems i.e MedHoK Prominence, Meditrac, Magellan and Care Director.
Senior Pharmacy Program Specialist
Inland Empire Health Plan
10.2019 - 01.2021
- Adhered to regulatory compliance goal: 24-hour completion of pharmacy prior authorizations and ensured quality and compliance issues were addressed in a timely manner.
- Ensured team was meeting minimum production expectations for prior authorization completion while also maintaining high quality assurance and accuracy
- Managed all queues within prior authorization processing application.
- Provided excellent customer service on phones during provider calls and when de-escalating Member calls.
- Developed and maintained standard work, desk top references, job aids and work flows.
- Provided training to on boarding team members and periodical retraining of current team members displaying gaps in understanding of standard work, job aids contributing to high quality assurance errors.
- Pharmacy assistance with online claim adjudication, Argus overrides, Coverage Determination processing of B vs. D medications, and Organizational Determination processing of Durable Medical Equipment and Diabetic Supply requests.
- Utilization of generated MedHok reports to assess incoming Prior Authorization inventory and completion based on MDI metrics.
Pharmacy Program Specialist
Inland Empire Health Plan
10.2014 - 10.2019
- Achieved highest processor for pharmacy prior authorization module.
- Maintained personal quality assurance percentage under 1%.
- Reviewed fax failed and member attachment reports to ensure deliverance and accuracy of outgoing and incoming pharmacy correspondence .
- Reviewed and decisioned in-office injections, home health medications and supplies within Pharmacy Utilization Management queue.
- Assisted training team in updating training material based on process improvements resulting from LEAN experiments and regulatory changes.
- Participated in LEAN trainings, multiple rapid improvement events and facilitated MDI huddles.
- Contributed to ensuring my productivity and quality assurance goals were meeting departmental expectations.
- Communicated with providers on issues related to IEHP formulary, non-formulary criteria, or policies and procedures
- Review of authorizations that included reviewing chart notes, and/or relevant clinical information to obtain clinical denial or approval of case.
- Assisted Pharmacy Call Center with inbound calls.
- Provided care coordination among varying departments for CCS services and disease therapy management.
Pharmacy Technician
MMP Enterprises INC.-DBA Vista Drug
07.1999 - 10.2014
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Managed opening and closing duties for pharmacy.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Managed special projects, such as drug protocol audits and inventory.
Education
General Education Classes 30 Credits -
Chaffey College
Rancho Cucamonga, CA2013
Pharmacy Technician License -
North Orange County Regional Occupational Program
Anaheim, CA2005
High School Diploma -
Woodrow Wilson High School
Long Beach, CA1999
Skills
- Exceptional organizational skills
- Bilingual: English and Spanish
- Ability to work in a team and individual environment
- Superior Interpersonal Skills
- Ability to work in a detail-oriented manner
- Training and mentoring
- Strong ability to strategize and prioritize effectively to accomplish multiple tasks
- Able to adapt to changing priorities and maintain cohesiveness
- Priority management
- Dedicated team member with focus of promoting team goals
- Team Leader
Timeline
Senior Pharmacy Medication Management Specialist
Inland Empire Health Plan
01.2021 - Current
Senior Pharmacy Program Specialist
Inland Empire Health Plan
10.2019 - 01.2021
Pharmacy Program Specialist
Inland Empire Health Plan
10.2014 - 10.2019
Pharmacy Technician
MMP Enterprises INC.-DBA Vista Drug
07.1999 - 10.2014
General Education Classes 30 Credits -
Chaffey College
Pharmacy Technician License -
North Orange County Regional Occupational Program
High School Diploma -
Woodrow Wilson High School