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Patient Care Prior Authorizations

Location:
Elk Grove Village, IL
Salary:
110,000
Posted:
November 09, 2023

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Resume:

Jay Patel

847-***-****

ad0z3k@r.postjobfree.com

https://www.linkedin.com/in/jaypatelpharmd/

Profile

Highly motivated and results-oriented pharmacist seeking a unique position where I can utilize my extensive clinical knowledge, patient care expertise, and passion for pharmacy to make a significant contribution to patient health and well-being.

Professional Experience

Registered Pharmacist – Bienestar Pharmacy January 2023 – Present

Provided synergistic care with the Alivio Medical Center across three distinct locations in underserved communities in the Chicagoland area by providing extensive pharmacy care (MTM, med rec, education)

Collaborated with prescribers and insurance programs to initiate and complete prior authorizations (PA’s) based on patient need, and generated solutions for incomplete or rejected PA’s as a physician advocate

Consulted with 340Basics to create affordable payment options for uninsured or underinsured patients

Took on managerial role by directing staff to ensure proper patient care and maximize efficiency

Pharmacist – Austin Outpatient Pharmacy at Loretto Hospital January 2023 – Present

Coordinated with the medical team at Loretto to provide patient centered care for discharge patients

Spearheaded the pharmacy workflow which included coordinating a payment plan to ensure patients receive the correct medications safely even if they are unable to provide insurance or payment

Communicated with the primary care providers to complete and follow the progressions for PA’s

Tracked prescriptions billed to the hospital and maintained a record of the outstanding balance daily

Humana Pharmacy Solutions April 2021 – October 2022

Reviewed prior authorizations to ensure that all of the pharmacy benefit manager’s requirements were met and protocol was followed accurately by ensuring the proper documentation and clinical justification was presented for each claim while under the supervision of PA team lead.

Reached out to prescribers to request information or to elaborate on the company’s decision to accept or deny PA’s while providing explanations for the decisions made in the approval process

Attended weekly meetings to remain vigilant of formulary changes that could impact PA’s

Documented objective data that backed up the decisions to accept or reject authorizations

Demonstrated adaptability by implementing clinical knowledge in a professional and remote setting

Ambulatory Care, Stroger Cook County Hospital November 2021- March 2022

Assisted with prior authorizations for patients of the outpatient rheumatology clinic who were receiving specialty medications such as IL-6 inhibitors, TNF inhibitors, JAK inhibitors

Conducted three-month follow-up calls to patients to collect data on safety and drug efficacy

Followed patients on step therapy and analyzed collected data to continue or swap therapies

Educated patients who were starting biologic injectable medications for the first time and counseled on proper injection technique, what to expect from the medication, and monitoring for side effects

Presented the results from an adherence study I conducted with patients to the rheumatology clinic

Regulatory Affairs - Astellas Pharmaceuticals (APPE) July 2021 – November 2021

Reviewed advertisement and promotional material with cross functional teams to verify presented material complies with regulatory guidelines set forth by the Food & Drug Administration (FDA)

Interpreted FDA guidance documents and warning letters to understand what is and what is not allowed in advertisement and promotion of pharmaceutical medications and devices

Interviewed pharmacists within the company to see how a PharmD can excel in industry

Inpatient medicine rotation - AMITA Health St. Joseph (APPE) September – November 2021

Rounded with the medical team as a pharmacist where I served as a resource to answer questions regarding medications

Conducted compatibility consults for NPO patients and provided alternate recommendations

Performed an in-service on pulmonary arterial hypertension where I educated the pharmacy team on this disease state and its treatment options

Follow-up up on drug information requests, such as how a calcium channel blocker overdose can be effectively and safely managed with high dose insulin therapy

Global Health Economic and Outcomes Research - EPI-Q (APPE) June-July 2021

Conducted systematic literature reviews of HEOR studies of pathology and treatments of different disease states, like atopic dermatitis and heart failure with reduced ejection fraction

Created a research proposal that sought to demonstrate the positive outcomes of the use of SGLT2 inhibitors in an inpatient setting in patients with heart failure

Discussed elements of research protocol design with data providers and pharmaceutical manufacturers to optimize

Pharmacy Intern - Austin Outpatient Pharmacy July 2021 – January 2023

Streamlined communications regarding patients between the hospital and the outpatient pharmacy by building rapport with the patients, nurses, and medication prescribers

Took on a leadership role as the head technician and trained newly hired pharmacy technicians on medication filling, data entry, prescription management, and providing proper patient care.

Pharmacy Intern - Jewel Osco September 2018 – January 2021

Managed workflow by triaging incoming orders, filling prescriptions, and overseeing prescription sales

Listened to patient’s primary complaints, made assessments, and followed up with recommendations

Updated patient information (recording medications, insurance information, etc.) via pharmacy software

Certified to administer vaccinations and entered insurance information for documentation and billing

Education

University of Illinois in Chicago College of Pharmacy Graduated May 2022

Doctor of Pharmacy, Cum Laude

University of Illinois Urbana-Champaign Graduated May 2015

Bachelor of Science in Molecular and Cellular Biology & Minor in Chemistry

Licensures & Achievements

Registered Pharmacist January 2023 – Present

License Number: 051.305350 Expiration: 3/31/2024

Clinical Application of Pharmacogenomics Certification 2022

Mayo Clinic Online CME

Dean’s List August 2018 – May 2022



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