Clinical Pharmacist
Resume:
RACHEL EVANS
**** * ***** ** ********, AZ *****
*******@*******.***
SUMMARY
10+ Years of Pharmacist experience, Active Pharmacist License in the State of Arizona, 2+ years of experience in Medicaid prior authorizations including specialty and telephonic prior authorizations, experience counseling patients and physicians about medications and alternatives in a clinical call center, 9 years as both PIC and staff pharmacist in a local retail pharmacy as well as high volume data verification and DUR evaluation for a mail order pharmacy.
PROFESSIONAL EXPERIENCE
UnitedHealthGroup, Phoenix, AZ. 09/2018-10/2019
Clinical HDP Pharmacist
Verify prescriptions including data entered into the system by data entry technicians for mail order patients.
Analyze prescription data including previous prescriptions and dosing, drug interactions, over max dose, allergies and medical conditions to decide if further clarification is required.
Apply a DUR hold and send the first fax or call the physician if further clarification is needed. Create tasks for drug formulations, over max dose, allergies and interactions when appropriate.
Answer the MD line to obtain new medications, obtain answers to clarifications that physicians may have received, explain any questions that a physician’s office may have as well as proactively search for any drug interactions and duplications of therapy to be clarified by the dr office. Warm transfer calls to other departments when necessary.
Analyze the Drug Utilization Review queue for potential drug interactions, allergies and duplication of therapy. Follow-up on claims in med-clarify faxback queue. Call or fax prescribers as well as call patients to clarify any questions we may have about their drug therapy.
Alorica Chandler, AZ. 11/2017-06/2018
Verification/DUR Pharmacist
Verify mail order prescriptions entered by technicians
Evaluate drug utilization reviews for drug interactions, allergies, dosing and age
Review eligibility for auto refill based on insurance reimbursement
Evaluate prescriptions for availability to override copay for PruGen assistance plan
Meet and exceed company’s quota for volume and quality
Aetna, Phoenix, AZ 05/2016 – 02/2017
Clinical Prior Authorization Pharmacist
Prior authorization pharmacist for several Medicaid plans
Evaluate incoming prior authorizations including specialty
Work with prior authorization team
Suggest ways to improve and provide similar decisions and explanations
US Script, Tempe, AZ 02/2015 – 04/2016
Plan Lead Prior Authorization Pharmacist
Lead pharmacist for state healthcare plan.
Supervise staff pharmacists.
Perform projects as directed by plan.
Time management reaching project goals while meeting turn around time for prior authorizations.
Review for three state Medicaid plans.
Review both non-specialty and specialty medications.
Interpret clinical information submitted by requesting physician (or physician representative) along with information in the patient's medical records to make determinations of medical necessity based on medication utilization and clinical appropriateness in line with current clinical guidelines and evidence based gold standard of care.
Review telephonic prior authorizations over the telephone for two of my three plans with prescribers and/or staff.
Make recommendations to physicians and other providers for alternative medication therapies based on health plan formulary and current gold standards of practice.
Performing peer to peer reviews by directly consulting with physicians and nurses.
Provide explanation and interpretations of health plan guidelines and provide recommendations to providers within area of expertise.
Interact with providers to gain additional clinical information when needed.
Train and educate pharmacists and support staff in the Prior Authorization team.
Recommend plan design changes, work with the health plan's pharmacy team, update plan guide and communicate recommendations to staff pharmacists in my primary plan.
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews.
Provide clinical guidance and support to various departments and address clinical related questions.
CVS Caremark, Phoenix, AZ 04/2014 – 10/2014
Clinical Consultant Pharmacist
Provide answers to clinical questions from patients and medical professionals in a call center environment.
Educate patients regarding drug information, dosing of medications, pill identification, drug interaction and side effect information.
Provide clinical alternatives to medications to patients and medical providers due to cost or side effects. Deescalate supervisor requested calls.
Evaluate stability of medications and counsel patients accordingly and approve reship when warranted. Transfer prescriptions to and from other pharmacists.
Take new prescriptions over the phone and enter into computer system.
Bashas' United Drug, Phoenix, AZ 06/2005 – 04/2014
Pharmacist in Charge
Supervise pharmacy associates, maintain stock, keep perpetual inventory and supervise biannual inventory, comply with state and federal laws and regulations as well as company policies and procedures, ensure customer satisfaction, use clinical skills to evaluate medications, drug interactions and disease states and make recommendations to physicians and patients, counsel patients on RX and OTC medications, fill and verify prescriptions, take new and transfer prescriptions, return medications to vendors including outdates.
Accomplishments
Spearhead increasing daily prescription volume by over 50% by providing excellent patient care and brainstorming ways to market the pharmacy to physician offices. Build and maintain trusting relationships with patients, improve patient outcomes and quality of life.
Skills Used: Clinical skills evaluating appropriate medication use and dosing, drug interactions and disease states, excellent patient care and counseling.
Skills
Pharmacy supervisor, retail pharmacy, retail management, pharmacy buyer, Medicaid, managed care, Medicaid plan management, prior authorizations, PBM, mail order, medication therapy management, compounding, LTC, disease state management, drug interactions, drug utilization review, acute care, drug metabolism, healthcare, community pharmacy, professional mentoring, customer service, patient consultation, team building, inventory control, retail sales, call quality and metrics, Microsoft Office.
EDUCATION
PharmD in Pharmacy, 2002-2005
Midwestern University, Glendale, AZ
Pre-Pharmacy studies, 1998-2002
Mesa Community College, Mesa, AZ
General studies, 1997-1998
Arizona State University, Tempe, AZ
CERTIFICATIONS/LICENSES
Registered Pharmacist
Arizona state board of pharmacy
License#: S014926
Issued: 07/22/2005/Expires: 10/31/2020
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