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Customer Service Pharmacy

Las Vegas, Nevada, United States
April 15, 2018

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**** *. ********** ***., #**** Las Vegas, NV 89128 Cell: 909-***-****

Executive Profile

Highly accomplished healthcare professional with 20 years of diverse experience in managing healthcare operations in both Medicare and Medicaid lines of business. Strategically focused leader with heavy emphasis on operational excellence and staff development. Seeking a senior management role in a professional healthcare environment where I can continue to develop and grow.

Skill Highlights

Strategic planning

Organizational change management

Staff development/ Training module creation

Excellent communication skills

Client account management/ Vendor management

Regulatory compliance/ Audit oversight

Problem management identification and resolution

New product development, expansion, training and implementation

Operational excellence

Organizational restructure and process improvements

Call center design & implementation

Professional Experience

Inland Empire Health Plan (

Rancho Cucamonga, CA

Director of Pharmacy Quality Assurance


Promoted to this role due to a positive CMS (Medicare) audit for my unit with minimal CAPs

Developed a Quality Assurance unit within the Pharmaceutical Services department with only 3 team members – unit grew to a total size of 10 new team members

Created the organizational structure; including the hiring/training/support of all new hires for the entire Pharmaceutical Services department – Operations, Formulary Management, Clinical Pharmacists, Call Center, Medicare & Administration

Created a comprehensive Quality Assurance plan and audit model to support all internal and external pharmacy related audits for both Medicare and Medicaid lines of business

Collaborated with all cross functional business units to ensure all CMS, DHCS, DMHC and internal audit regulations were met if not exceeded

Trained the newly hired Director of Pharmacy Operations that backfilled my previous position

Director of Pharmacy Operations


Promoted to the 1st Director of Pharmacy Operations position

Developed the 1st Pharmacy department Call Center which begin taking direct member calls – worked closely with Director of Member Services; presented all pharmacy updates at Member Service weekly meetings

oExpanded call center out for Medicare line of business and Medicaid separately – included multiple queues to ensure highest service levels and regulations were met or exceeded

Assisted with a large company move from San Bernardino to Rancho Cucamonga

Directed a team of 60+ pharmacy technicians who were responsible for prior authorization review, pharmacy claims determinations, call center functions, training & quality assurance procedures

Worked to redesign our prior authorization process using a new medical management software

Interviewed all team members within the Operations unit in Pharmacy, conducted all final performance review meetings and processed all Human Resource paperwork

o40+ team members were hired and trained in just over 1 year due to rapid membership growth

oSuccessfully retained 95% of those hired during this time

oProudly assisted with the promotion of over 10 team members into supervisory/management roles - provided guidance and mentorship whenever needed

Collaborated with multiple departments regularly to continuously improve processes

Pharmacy Operations Manager

10/2007- 04/2013

Promoted to 1st Pharmacy Operations Manager position – team had grown to over 20 pharmacy technicians and 5 support staff

Worked in partnership with the Information Technology department to design and implement an internal internet-based application for logging prior authorization history

oAllowed Member Services the ability to provide real time information regarding pharmacy prior authorization requests to members

oOther internal departments would now be able to access pharmacy notes to assist with their department needs (i.e. Grievance & Appeals/Care Management/Utilization Management)

Identified the need for training materials to be formally documented and streamlined

Created Standard Operating Procedures (SOPs) – assisted other Medical service teams to unify processes

Developed and implemented a department training manual

Collaborated with Claims department to create a 100% paperless process between our teams

Attended and spoke at many inter-department meetings to ensure all materials were kept up to date

Pharmacy Program Specialist Supervisor


Became 1st Pharmacy department Pharmacy Program Specialist Supervisor

Ensured all Pharmaceutical prior authorizations were handled appropriately and timely based upon set regulatory guidelines

Assisted with all internal auditing procedures; including documenting the auditing process

Interviewed, hired, trained and coached all incoming pharmacy technicians

o98% score for customer service based upon provider satisfaction surveys

o100% of provider calls answered within 3 rings

Boosted team morale by displaying a positive example and working hard to provide a healthy work environment

Sr. Pharmacy Program Specialist (PPS)


Reviewed & made determinations on pharmacy prior authorization requests based on company policy & regulatory guidelines

Coordinated medical history review with physician offices & pharmacies to assist with all member needs

Provided exceptional customer service via telephone & email to external providers and internal departments

Displayed a high level of self-motivation while attempting to accomplish departmental goals & exceed management expectations


Rite Aid

Riverside, CA

Pharmacy Technician


Entered new patient profiles and prescriptions into medication management software system

Provided friendly customer services at prescription drop- off and pick up counters

Assisted Pharmacist with safely and accurately dispensing medications

Efficiently answered multi-line phones and processed high volume order requests

Wheelhouse Skating Rink

Hemet, CA

Assistant Manager


Greeted & assisted each customer –handled inquires, complaints and injury reports

Managed youth roller hockey program – registrations, score-keepings, referee reimbursements

Directed and supervised employees engaged in sales, inventory management & customer service

Handled reconciling all cash register tills at end of shifts, bank deposits & employee discrepancies

Completed weekly schedules per payroll policy & turned in weekly timesheets to bookkeeper


California Board of Pharmacy

Sacramento, CA

Received California pharmacy technician license in 1997. Active license# TCH25257

University of La Verne

La Verne, CA

Coursework in general undergraduate studies

Mt San Jacinto College

San Jacinto, CA

Coursework in early childhood development. Earned 15 units to teach preschool-aged children

Hemet High School

Hemet, CA

Graduated with Highest Honors. Provided peer counseling sessions to fellow classmates

References available upon request

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