Manage Care Pharmacist
Resume:
EDWINA L. JONES
Lawrenceville, GA 30043
********@***.***
EDUCATION: MERCER UNIVERSITY SOUTHERN SCHOOL OF PHARMACY
Doctor of Pharmacy
Degree Conferred: May 1998
CLARK ATLANTA UNIVERSITY
Master of Business Administration
Degree Conferred: May 1991
Concentrations: Marketing and Finance
ALABAMA A & M UNIVERSITY
Bachelor of Science
Degree Conferred: July 1986
Major: Zoology
Minor: Chemistry
SKILLS:
Management of staff consisting of Pharmacist, Pharmacy Technicians, Medical Assistants, and Nurses.
Written and oral communication skills from experience as an instructor, medical educator, clinical liaison with Medicaid, Medicare and commercial clients, and Regional Associate Vice-President of Pharmacy.
Strong time management and organizational skills from managerial positions, managed care and retail pharmacist positions, and laboratory technician positions.
Strong organizational skills from implementing state pharmacy programs.
Strong analytical skills from years of scientific research experiences.
Strong drug information skills from retail and managed care positions as a clinical pharmacist.
EXPERIENCE:
October 2015- US Script/Centene Corporation Atlanta, Georgia
Present Pharmacy Director
Develop and implement clinical drug policies and guidelines that assure appropriate utilization and cost control.
Complete therapeutic class reviews, drug monographs, and formulary
recommendations to the Pharmacy and Therapeutics Committee.
Submit formulary change requests and approve testing of changes submitted for all Medicaid plans prior to changes being implemented.
Collaborate with Compliance teams to ensure pharmacy guidelines and policies and procedures are operating according to state and federal regulations.
March 2015- Healthcare Scouts, Inc. Winter Park, Florida
October 2015 Contract Clinical Pharmacist, US Script
Reviewed clinical prior authorization requests for health plans.
Conducted peer-to-peer consultations with physicians.
August 2012- Amerigroup, Inc Atlanta, Georgia
February 2015 Associate Vice-President, Pharmacy, South Region
Reported financial, operational and quality metrics and trends to the health plan related to the Pharmacy program.
Assisted in the development and implementation of health plan pharmacy medical earnings initiatives (MEIs) to ensure health plan goals are met.
Active participant and Amerigroup representative on the state Drug Utilization Review Board, state Pharmacy & Therapeutics (P&T) committee, and/or other state meetings as necessary.
Active participant in health plan Medical Advisory Committee (MAC) and/or Quality Management Committee (QMC) meetings.
Collaborated in the development and implementation of point of sale interventions, retrospective drug utilization reviews, polypharmacy, pharmacist case management, medication therapy management, disease management, lock-in, and other clinical programs.
Subject matter expert for new business implemented within my region.
Collaborated with Compliance teams to ensure pharmacy programs operated according to state and CMS requirements.
Ensured the provision of pharmacy clinical support for the health plans.
Optimized clinical drug policies and related clinical protocols to assure appropriate utilization and cost control.
Maximized quality assurance activities to ensure regulatory and clinical policy compliance.
Co-chair of the Behavioral Health Subcommittee which reviewed and made
recommendations on psychotherapeutic drugs for the company’s health plans.
Member of the Georgia Drug Utilization Review Board which made decisions on drug utilization for state Medicaid recipients.
June 2011 - Amerigroup, Inc Atlanta, Georgia
August 2012 Clinical Pharmacy Director, South Region
November 2006- Amerigroup, Inc Atlanta, Georgia
June 2011 Clinical Pharmacy Manager
March 2005- Pharmacare Specialty Pharmacy Atlanta, Georgia
October 2006 Staff Pharmacist
June 2004- Express Scripts, Inc Roswell, Georgia
February 2005 Clinical Program Manager
October 2002- ACS, Inc Atlanta, Georgia
June 2004 Clinical Services Manager (Clinical Liaison)
August 2000- ACS, Inc Atlanta, Georgia
October 2002 DUR Clinical Manager
March 2000- ACS, Inc Atlanta, Georgia
October 2002 DUR Supervisor
October 1998- CVS (FORMERLY REVCO/BIG B DRUGS) Atlanta, Georgia
June 2003 Staff Pharmacist
April 1993- ETOWAH QUALITY OF LIFE Gadsden, Alabama
August 1994 Sickle Cell Coordinator (Medical Educator)
February 1994- ETOWAH QUALITY OF LIFE Gadsden, Alabama
August 1994 Marketing Director
March 1992- GADSDEN STATE COMMUNITY COLLEGE Gadsden, Alabama
January 1993 Biology Instructor
September 1988- MOREHOUSE SCHOOL OF MEDICINE Atlanta, Georgia
August 1989 Laboratory Technician III
June 1987- LAWRENCE LIVERMORE NATIONAL LAB Livermore, California
August 1987 Biomedical Scientist - Summer Internship
September 1986- ATLANTA UNIVERSITY Atlanta, Georgia
August 1988 Graduate Research Assistant
Contact this candidate