Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Timeline
Generic

Nader Alramli

Oak Lawn,IL

Summary

Dynamic Prior Authorization Pharmacist at CVS Health with expertise in clinical decision making and medication therapy management. Proven track record in enhancing formulary management and ensuring compliance with CMS guidelines. Recognized for exceptional attention to detail and effective patient counseling, driving quality outcomes in pharmaceutical care.

Overview

2
2
years of professional experience
1
1
Certification

Work History

Prior Authorization Pharmacist

CVS Health
01.2025 - Current
  • Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests
  • Provide clear, concise, and accurate documentation for case reviews.
  • Contacting providers, if needed, for clinical information to decision cases
  • Utilize work instructions and Medicare guidelines for accurate case processing.
  • Comply with CMS mandated timelines and department productivity and quality standards.
  • Acquire and utilize clinical judgement and knowledge, drug compendia resources, relevant and changing work instructions, and CMS Medicare guidance.
  • Using clinical judgement and resources to follow step therapy for formulary alternatives.
  • Follow plan criteria for GLP-1 agonists, weight loss management, JAK inhibitors, retinoid products and several others.

Clinical Pharmacist - Contract

OptumRx
01.2024 - 01.2025
  • Assess medication regimen for unnecessary medications, ineffective medications, inappropriate doses, and adverse drug reactions.
  • Utilize prescription claims data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program protocols
  • Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests
  • Participate in clinical quality audits and inter-rater reliability testing
  • Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
  • Providing clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions and therapeutic substitution
  • Engage members telephonically and schedule pharmacist consultation appointments with members that participate in any of the clinical programs supported by the Clinical Engagement Services Center
  • Active participation in departmental meetings to improve clinical programs and enhance processes
  • Developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers.
  • Conducting Comprehensive Medication Reviews (CMR) and Targeted Medication Reviews (TMR) for medicare patients
  • Counsel medicare patients on prescriptions and assisting in any questions or concerns

Pharmacist

CVS Health
02.2023 - 02.2024
  • Educate customers on safe medication administration, including potential side effects and interactions with other drugs
  • Prepared and dispensed prescription medications alongside experienced pharmacy technicians and provided education on potential side effects and health risks
  • Verified and filled prescriptions, educated patients on safe drug administration, oversaw a team of multiple pharmacy technicians and achieved goals of pharmacy
  • Managed drug inventory levels, ordered medications and supplies, replenished inventory, and managed relationships with suppliers
  • Performed patient drug utilization reviews and clinical interventions to promote safe and cost-effective medication use
  • Compounded, prepared, and dispensed medications in accordance with established regulations and standards

Education

Doctor of Pharmacy - PharmD - Pharmacy

Midwestern University (IL)
Downers Grove, IL
03.2023

Associate's degree - Social Sciences

Moraine Valley Community College
Palos Hills, IL
2018

Skills

  • Clinical assessment expertise
  • Prior authorization expertise
  • Medication management strategies
  • Utilization review skills
  • Formulary oversight
  • Patient education and counseling
  • Quality assurance practices
  • Collaborative teamwork
  • Detail-oriented approach
  • Immunization delivery
  • Medicare and Medicaid navigation
  • Supply chain management
  • Critical thinking
  • Formulary exception reviews
  • Comprehensive Medication Management

Accomplishments

Registered Pharmacist IDFPR October 2023

Registered Pharmacist in the state of Illinois

License number: 051305919

Certification

Certified Immunizer American Pharmacists Association September 2020

Completion of Immunization training.

Advanced Cardiac Life Support ACLS September 2020

Timeline

Prior Authorization Pharmacist

CVS Health
01.2025 - Current

Clinical Pharmacist - Contract

OptumRx
01.2024 - 01.2025

Pharmacist

CVS Health
02.2023 - 02.2024

Doctor of Pharmacy - PharmD - Pharmacy

Midwestern University (IL)

Associate's degree - Social Sciences

Moraine Valley Community College

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