SHANNON BARTON
Portland,Oregon
Summary
Clinical pharmacy leader focused on improving patient outcomes through medication policy development, formulary analysis, and collaborative care across multidisciplinary teams. Known for strengthening workflows, supporting prior authorization and outreach operations, and helping reduce health plan spending through careful review, process optimization, and data-informed decision-making.
Overview
20
20
years of professional experience
Work History
Manager, Clinical Pharmacy Operations
Cambia Health Solutions
Portland, OR
03.2021 - 08.2026
- Led a team of 8 pharmacists, ensuring high productivity and excellent cross team collaboration.
- Planned, implemented, and sustained the launch of numerous projects including a new prior authorization database, several large scale cost-saving initiatives, and onboarding of new clients
- Managed compliance with healthcare regulations, industry standards, and internal policy standards.
- Coordinated process improvements for prior authorization workflows, increasing efficiency and accuracy in clinical operations.
- Partnered with providers and vendors on operational issue resolution.
- Reviewed reports to support planning and daily decision-making, enabling informed operational strategies.
- Coached, mentored and trained team members to improve their job performance.
- Provided leadership during times of organizational change or crisis situations.
- Recruited and hired qualified candidates to fill open positions.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Enhanced team morale and retention through recognition programs and career development opportunities, fostering a positive work environment.
DIRECTOR OF CLINICAL RESEARCH
WITHME HEALTH
12.2019 - 03.2021
- Acted as subject matter expert in developing and implementing pharmacy prior authorization database, maintaining compliance with regulatory standards through comprehensive documentation.
- Led creation of member outreach processes and workflows for tech and PA pharmacists; supported clinical outreach team in benefit and formulary design while training new clinical pharmacists.
- Developed medication protocols, class reviews, and clinical snapshots for newly approved medications; created clinical resource tool for practice guidelines and maintained medication pipeline.
- Examined, validated and updated clinical data for the product analytics team; created and tested clinical logic for implementation of assigned tasks to clinical outreach staff.
- Performed impact analysis for transitioning over 10,000 new clients; collaborated and assisted in the development of formulary impact letters; created GPI lists for benefit worksheets of new clients.
- Reviewed and edited sales and marketing website articles.
CLINICAL PHARMACIST
PROVIDENCE HEALTH PLAN
04.2019 - 12.2019
- Delivered comprehensive medication therapy management services to optimize medication regimens. This included identifying safety issues, answering pharmaceutical-related questions, determining lower cost treatment regimens and aiding in development of healthy lifestyle options.
- Reviewed prior authorization requests for Commercial, Medicare Part D and Medicaid lines of business.
- Directed implementation of Real Time Benefits (RTB) project.
- Identifying the health plan's high volume, high cost medications and their lower cost, non-prior authorized alternatives to decrease overall costs, reduce prior authorization volume and improve efficiencies; reviewing and updating RTB provider messaging to be easily understandable; working with external customers to ensure proper end to end testing of the RTB tool and to optimize provider utilization of RTB tool through targeted communication.
- Managed Electronic Prior Authorization (ePA) project which included:.
- Creating list of ePA eligible products by reviewing utilization of all PA products and determining which PA products had the highest volume to make the most impact; overseeing PA policies to certify compatibility within the ePA tool and developing new PA question sets and logic for policies that did not function within the tool; meeting weekly and ad hoc with external customers to ensure proper end to end testing of the ePA project.
CLINICAL PHARMACIST
FAMILY CARE HEALTH PLAN
05.2013 - 07.2018
- Reviewed prior authorization requests and first level appeals for Medicare Part D and Medicaid lines of business; represented the organization in member appeal hearings and Medicare Part D clinical decision-making audits.
- Oversaw Oregon State and Medicare Part D quality metrics; performed formulary impact analyses; wrote communications to members and providers.
- Contacted Medicare Part D members to discuss OTC and prescription medications, identified barriers to medication adherence, facilitated early refills for medication synchronization, and promoted mail order and 90 day fills for optimal adherence.
- Met routinely with Medicare case managers to transition members from hospital and SNF stays by informing staff of formulary and medication policies, performing retrospective medication reviews, aiding in expediency of level of care change authorizations, promoting adherence to medication regimens, and preventing readmissions.
- Created and presented medication policies as well as formulary updates, STAR measure updates and top drug spend to Pharmacy and Therapeutics Committee on a quarterly basis.
PRIOR AUTHORIZATION MANAGER
CATAMARAN RX
06.2012 - 05.2013
- Provided oversight and management of the Prior Authorization staff (25 people) including all clinical activities and quality assurance of the PA dept. Department staff included: pharmacists, supervisors, quality assurance tech/trainer, PA technicians, call techs and clerks.
- Worked with external and internal personnel to help maintain strong client relationships and ensured all client requests were met in a timely manner.
- Reviewed volume and nature of workload handled by PA staff; informed and updated department with turnaround times and workload status reports; presented recommendations to management and compliance department to correct potential problems; identified training/education opportunities.
- Evaluated productivity and quality of work; reported individual and department performance on a weekly and monthly basis; provided yearly performance appraisals and developed goal setting including general, reach, and stretch goals.
CLINICAL PHARMACIST
REGENCE BLUE CROSS BLUE SHIELD
08.2006 - 06.2012
- Reviewed prior authorizations and first level appeals for Medicare Part D and Commercial lines of business.
- Handled escalated clinical calls from providers and members, providing details about medication policies, the formulary status of medications and clinical use.
- Maintained independent review organization reports and presented data to pharmacy staff and medical directors twice yearly.
- Improved operational processes – letter templates, technician guidance, and website content.
- Additional work history available upon request.
Education
BACHELOR OF SCIENCE - PHARMACY
UNIVERSITY OF LOUISIANA AT MONROE
Monroe, LA05-1994
Skills
- Program and Project Development and Implementation
- Process Organization and Optimization
- Adaptability and Flexibility
- Ownership and Accountability
- Connecting with individuals and developing strong interpersonal relationships
- Delivered over $10M in savings through Federal Employee Program (FEP) medical drug prior authorization pilot and initiatives at Cambia Heath Plan
- Decreased internal call volume for pharmacist and technician staff from over 60 calls per day to 10 calls per day at Providence Health Plan
- Decreased Medicare Part D high risk medication STAR score from 14% to 6% in one quarter at FamilyCare Health Plan
- Received President's award for excellent customer service at Safeway Pharmacy
ACTIVITIES
- Active member of the Mysti Krewe of Nimbus, a social and plepleasure club who organizes and participates in numerous parades throughout the Portland metro area
- Chaired Cultural Subcommittee of Diversity, Inclusion, and Equality Group at WithMe Health.
- Planned and oversaw all Pharmacy Week activities for department of over 80 employees at Providence Health Plan.
- Planned and oversaw health-related activities for FamilyCare employees on a semi-annual basis
- Volunteered at Dress for Success providing free makeovers to women interviewing for jobs.
Affiliations
- Active member of social and pleasure club, the Mysti Krewe of Nimbus
Timeline
Manager, Clinical Pharmacy Operations
Cambia Health Solutions
03.2021 - 08.2026
DIRECTOR OF CLINICAL RESEARCH
WITHME HEALTH
12.2019 - 03.2021
CLINICAL PHARMACIST
PROVIDENCE HEALTH PLAN
04.2019 - 12.2019
CLINICAL PHARMACIST
FAMILY CARE HEALTH PLAN
05.2013 - 07.2018
PRIOR AUTHORIZATION MANAGER
CATAMARAN RX
06.2012 - 05.2013
CLINICAL PHARMACIST
REGENCE BLUE CROSS BLUE SHIELD
08.2006 - 06.2012
BACHELOR OF SCIENCE - PHARMACY
UNIVERSITY OF LOUISIANA AT MONROE