Samah Abdo
Medix- Capital Rx/Judi Health
ORLANDO,FL
1
Certification
11
years of professional experience
Detail-oriented Licensed Pharmacist in Florida with 11 years of telehealth experience and expertise in prior authorization within managed care. Consistently reviews cases efficiently while achieving high-quality standards. Proficient in leveraging resources such as Lexicomp, Drugdex, and NCCN, along with pharmacy programs like DPAS and Medhok, to support informed decision-making.
Work History
Prior Authorization Pharmacist
7 Months- Reviewed and made timely, evidence-based decisions on prior authorizations, appeals, and override requests, improving approval rates through application of clinical guidelines and benefit criteria.
- Ensured compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans, mitigating risk of non-compliance penalties.
- Accurately documented clinical decisions and maintained thorough records in accordance with regulatory and accreditation standards (URAC/NCQA).
- Responded to clinical inquiries from members, prescribers, and pharmacies, fostering trust and clarity through professionalism, active listening, and a patient-centered approach.
- Stayed current with clinical prescribing guidelines, internal policies, and regulatory changes, and applied them to daily responsibilities.
- Followed all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
- Identified and reported potential fraud, waste, and abuse.
Clinical Review Pharmacist
2 Years 7 Months- Responsible for reviewing clinical coverage via research and clinical compendium such as Lexicomp, Drugdex, American Hospital Formulary Service (AHFS), and National Comprehensive Cancer Network (NCCN).
- Initiated and received prescriber communication to recommend changes for medication therapies, enhancing patient care.
- Demonstrated ability to meet performance expectations, reviewing an average of 50 cases per hour while maintaining 98-100% Quality.
- Reviewed clinical coverage by researching clinical compendiums such as Lexicomp, Drugdex, American Hospital Formulary Service (AHFS), and National Comprehensive Cancer Network (NCCN).
- Initiated as well as received prescriber communication regarding suggested changes for medication therapies.
- Reviewed medication exception requests and conducted data analysis to support clinical projects and decision-making.
- Supported training and development of new and existing team members.
- Supported leadership with special projects and process improvements.
Clinical Review Pharmacist
3 Years- Perform comprehensive medication reviews and other health care quality improvement interventions.
- Initiate prescriber communication regarding suggested changes for medication therapies.
- Partner with the patient to solve for non-adherence issues as well as work with the patient and the prescriber to assess the need for supplemental medications based on the unique needs of the patient and their disease state.
- Partnered with the patient to address non-adherence issues and collaborated with the prescriber to evaluate supplemental medication needs.
- Conducted proactive analysis of care setting drug utilization data to identify trends and developed strategies that implemented comprehensive programs aimed at improving patient outcomes.
- Promote medication safety and compliance.
- Ensured medication safety through patient education
- Contributed to internal quality performance and improvement initiatives within EMS, enhancing overall care standards.
Clinical Review Pharmacist
6 Months- Reviewed Prior Authorization requests for coverage and made determinations for appropriate drug products.
- Initiated and received prescriber communications to recommend changes in medication therapies for improved patient outcomes.
- Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting client’s expectations regarding efficiency, services levels, privacy maintenance and quality decision making.
- Reviewed clinical coverage by conducting research using resources such as Lexicomp, Drugdex, American Hospital Formulary Service (AHFS), and National Comprehensive Cancer Network (NCCN).
- Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting client’s expectations regarding efficiency, service levels, privacy maintenance and quality decision making.
- Reviewed medication exception requests and conducted various clinical projects.
- Contract, Assignment Completed
- Assessed clinical information for accuracy, ensuring timely approval of prescription medications.
Clinical Review Pharmacist
8 Months- Reviewed prior authorization requests, determining appropriate drug products to ensure optimal patient care.
- Responsible for reviewing clinical coverage via research and clinical compendium such as Lexicomp, Drugdex, American Hospital Formulary Service (AHFS) and National Comprehensive Cancer Network (NCCN).
- Reviewed clinical coverage through research and clinical compendium such as Lexicomp, Drugdex, American Hospital Formulary Service (AHFS), and National Comprehensive Cancer Network (NCCN).
- Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting client’s expectations regarding efficiency, service levels, privacy maintenance and quality decision making.
- Analyzed medication exception requests and conducted various clinical projects.
- Contract, Assignment Completed
Clinical Review Pharmacist
6 Months- Conducted the final review of requests for quality assurance, verifying accuracy and adherence to CMS (Centers for Medicaid and Medicare Services) rules and regulations.
- Reviewed clinical coverage determinations and appeals to ensure compliance with Medicare and client-specific requirements.
- Reviewed clinical coverage via research and clinical compendium such as Lexicomp, Drugdex, American Hospital Formulary Service (AHFS) and National Comprehensive Cancer Network (NCCN).
- Knowledgeable in all aspects of coverage determination and appeals process and assisted in meeting client’s expectations regarding efficiency, service levels, privacy maintenance, and quality decision making.
- Reviewed medication exception requests and completed data analysis.
- Contract, Assignment Completed
Clinical Review Pharmacist
6 Months- Applied clinical coverage determination and appeals based on Medicare and client-specific requirements to ensure compliance and optimal patient care.
- Reviewed clinical coverage through research and clinical compendium, including Lexicomp, Drugdex, American Hospital Formulary Service (AHFS), and National Comprehensive Cancer Network (NCCN).
- Facilitated coverage determination and appeals process to meet client expectations for efficiency, service levels, privacy maintenance, and quality decision-making.
- Reviewed medication exception requests and completed data analysis.
Education
Master of Pharmacology - Clinical Pharmacy
Bachelor of Pharmacy
Certification
Registered Pharmacist, Florida - #PS54357 – Expires: 2027-09-30
Timeline
Prior Authorization Pharmacist
Medix- Capital Rx/Judi Health
10.2025 - 05.2026Read More
Clinical Review Pharmacist
CVS Caremark Prior Authorization department
10.2022 - 05.2025Read More
Clinical Review Pharmacist
TDS - EMS
09.2019 - 09.2022Read More
Clinical Review Pharmacist
Envolve Pharmacy solutions - Centene
06.2018 - 12.2018Read More
Clinical Review Pharmacist
Aetna
01.2017 - 09.2017Read More
Clinical Review Pharmacist
Cigna
06.2016 - 12.2016Read More
Clinical Review Pharmacist
CVS Caremark – Xerox
11.2015 - 05.2016Read More
University of Medical Sciences and Technology
Bachelor of Pharmacy
Read More
University of Medical Sciences and Technology
Master of Pharmacology from Clinical Pharmacy
Read More