Mike Dotson, Pharm.D.
Molina Healthcare
Johnson City,United States
12
years of professional experience
1
Certification
Dynamic Clinical Pharmacist with over 12 years of extensive pharmacy practice, specializing in Utilization Management. Expertise in leveraging evidence-based clinical guidelines, FDA labeling, payer policies, and regulatory requirements to ensure precise and justifiable coverage determinations for pharmacy and medical-benefit therapies. Proven leader skilled in mentoring pharmacists, enhancing workflow efficiency, and collaborating with multidisciplinary teams to address complex clinical challenges. Committed to promoting optimal medication utilization, improving patient outcomes, and delivering high-quality, cost-effective care within managed care environments.
Work History
Utilization Management Clinical Pharmacist
1 Year 9 Months- Processed up to 70 cases daily within an 8-hour work period, ensuring quality standard compliance across completed casework.
- Oversaw UM and PA processes for Medicaid and Marketplace populations by applying evidence-based guidelines, formulary management principles, and CMS compliance standards to ensure clinically appropriate, cost-effective use of pharmacy and medical-benefit therapies, including specialty and high-cost medications.
- Reviewed prior authorization formulary exceptions, step-therapy overrides, continuation-of-therapy cases, and appeal submissions to determine medical necessity, ensure formulary compliance, and optimize appropriate medication utilization.
- Assessed specialty drugs, biologics, injectables, and infusion therapies for clinical appropriateness, safety considerations, and compliance with evidence-based guidelines and payer coverage requirements.
- Applied FDA labeling, clinical practice guidelines, and health plan policies to support utilization management decisions with documented, audit-ready consistency.
- Facilitated peer-to-peer discussions with prescribers to explain clinical reasoning, support medical necessity decisions, and resolve complex prior authorization and utilization management cases.
- Reviewed prior therapies treatment failures and contraindications, and interpreted step therapy requirements to guide appropriate drug selection and maintain formulary integrity.
- Audited J-code billing requests for dosing frequency, duration, and unit accuracy to support correct medical-benefit reimbursement and reduce claim discrepancies.
- Synthesized clinical documentation for prior authorization review, ensuring alignment with CMS regulations, Medicaid requirements, and payer policies.
- Verified CMS guideline alignment, State Medicaid regulatory compliance, and health plan contract adherence while sustaining productivity and turnaround-time performance.
- Assisted utilization management workflow redesign efforts to improve review standardization and support timely patient care.
- Reviewed medication regimens for safety, effectiveness, and potential drug interactions.
- Evaluated prior authorization requests for medical necessity and formulary compliance.
Medication Adherence Clinical Pharmacist
9 Months- Executed high-volume call activity exceeding 60 calls per day and sustained closing performance with close rate above 45%.
- Conducted personalized medication therapy management and counseling to drive superior patient health outcomes and lower hospital readmission rates.
- Evaluated medication regimens in detail to identify gaps in care and optimize therapeutic outcomes for patients.
- Provided patient-focused counseling on medication use and adherence to promote improved health outcomes and quality of life.
- Developed and applied structured checklists to standardize pharmacy processes and enhance pharmacy operational efficiency.
- Strategically prioritized tasks, coordinated workflow scheduling, and organized workstreams to increase efficiency.
- Mentored and trained new pharmacists and student pharmacists to sustain collaborative, growth-oriented workplace culture.
- Coordinated communication and collaboration across multidisciplinary healthcare teams to ensure holistic patient care and maximize treatment plan effectiveness.
- Reviewed medication therapies for appropriateness, interactions, and contraindications across complex patient cases.
Business Owner
4 Years 9 Months- Successfully operated three stationary locations and event bus in Tennessee, achieving 50% annual revenue growth.
- Developed and managed high-performing team through recruitment, training, performance management, leading to improved employee retention.
- Reduced overhead costs and negotiated supplier contracts, optimizing workflow to increase profitability.
Medication Therapy Management (MTM) Certified Clinical Pharmacist
4 Years 11 Months- Performed MTMs consistently to support the highest performance outcomes, achieving #1 ranking out of 100 pharmacists for five consecutive quarters.
- Developed cold-calling training for the pharmacy team, strengthening call approach and reducing hang-ups.
- Designed and deployed evidence-based MTM checklist to standardize medication therapy management workflow, strengthening overall quality and patient medication experience.
- Delivered medication therapy management and patient counseling to diverse populations with multiple health conditions to improve patient outcomes.
- Conducted comprehensive drug utilization reviews, evaluating medication profiles to flag potential drug interactions or contraindications and ensure safe adherence to prescribed medication regimens.
- Conducted onboarding mentorship and hands-on training for new pharmacists, promoting supportive team environment and clinical excellence.
- Reviewed patient knowledge of prescribed medication therapy to customize counseling based on individual patient needs.
- Oversaw daily task prioritization and workflow coordination to increase process efficiency and overall effectiveness.
- Optimized medication regimens by evaluating lab results, assessing vital signs, and tracking clinical response to medications across complex patient populations.
- Reviewed and assessed non-formulary medication profiles to determine generic alternatives.
Sterile Compounding Infusion Pharmacist
4 Months- Increased business volume by 30% through efficiency improvements, relationship building, and consistent delivery of commitments.
- Assessed infusion medication regimens for complex patients, reviewed potential drug interactions, and developed alternative treatment strategies when necessary.
- Developed and implemented evidence-based clinical pharmacy protocols and guidelines to strengthen pharmacy service delivery.
- Monitored antibiotic usage patterns to inform antimicrobial stewardship recommendations for targeted improvement.
- Delivered patient training on correct infusion medication use and adherence practices, supporting improved health outcomes and lower hospital readmissions.
- Partnered with interdisciplinary healthcare teams to align care delivery for optimal patient care and improved treatment outcomes.
- Established durable partnerships with healthcare providers to streamline communication and strengthen collaborative efforts for patient care coordination.
- Executed cost-saving initiatives by overseeing formulary management and conducting utilization reviews to promote efficient resource use and maintain high-quality patient care standards.
- Supervised end-to-end pharmacy inventory management, ensuring accurate medication tracking for regulatory compliance.
- Assisted with quality improvement initiatives focused on optimizing clinical pharmacy services within organization.
- Tracked department performance metrics and evaluated trends to drive department performance enhancements.
- Verified home infusion prescriptions for accuracy, dosing, and clinical appropriateness before preparation.
- Oversaw sterile compounding workflows to ensure USP compliance and product integrity.
Director of Pharmacy
7 Months- Directed long-term care pharmacy prescription supply workflow, maintaining monthly dispensing volume of 15,000+ prescriptions.
- Implemented dispensing automation technologies to streamline prescription dispensing workflows, improving accuracy and efficiency within the pharmacy department and reducing pharmacist labor cost by 30%.
- Led implementation of barcode scanning systems integrated into filling workflows to reduce filling errors by 60% and enhance patient safety.
- Supervised regulatory compliance oversight, ensuring pharmacy practice remained consistent with applicable state and federal guidelines.
- Executed scheduled facility inspections, documented improvement needs, and addressed identified hazards to ensure continued regulatory compliance for staff and residents.
- Developed operational procedures for sterile compounding laboratory launch and obtained USP 797 certification.
- Owned pharmacy department continuous improvement initiatives focused on workflow optimization and improved productivity.
- Managed day-to-day communication with team members, physicians, and community organizations to align on high-quality patient care.
- Recruited and hired team members, led training and onboarding, and delivered direct supervision alongside ongoing development and continuing education.
- Managed development and ongoing updates of policies and procedures to support compliance with HIPAA benefits administration and general liability requirements.
- Ordered pharmacy supplies and monitored inventory levels to ensure timely replenishment and prevent overages and shortages.
- Directed pharmacy operations, ensuring compliant medication dispensing for extended care residents.
- Oversaw order verification, prescription processing, and accurate clinical documentation.
Education
Doctorate of Pharmacy (Pharm. D.) - Pharmacy
Master of Science - Chemistry, Mathematics
Skills
Drug utilization review
Clinical drug expertise
Written communication
Medical documentation
Clinical guideline application
Optimized patient services
Multistate pharmacy licensure
Strong written communication
Certification
APhA Immunization Certification, National Patient-Centered Diabetes Care Certification, Life Support,
Pharmacist Licenses
Florida, Tennessee, New York, Washington
Timeline
Utilization Management Clinical Pharmacist
Molina Healthcare
01.2025 - CurrentRead More
Medication Adherence Clinical Pharmacist
Molina Healthcare
03.2024 - 12.2024Read More
Business Owner
Mike's Shaved Ice
03.2019 - 12.2023Read More
Medication Therapy Management (MTM) Certified Clinical Pharmacist
UnitedHealth Group
03.2016 - 02.2021Read More
Sterile Compounding Infusion Pharmacist
Care Solutions Home Infusion Pharmacy
09.2015 - 01.2016Read More
Director of Pharmacy
Bradley Extended Care Pharmacy
02.2015 - 09.2015Read More
South College School of Pharmacy
Doctorate of Pharmacy (Pharm. D.) from Pharmacy
Read More
East Tennessee State University
Master of Science from Chemistry, Mathematics
Read More