Manager Pharmacy

Location:

Missouri City, TX

Posted:

July 31, 2020

Contact this candidate

Resume:

Mona S. Desai, Pharm.D.

**** ******** ***** ****

Missouri City, TX 77459

E-mail: *********@*****.***

Home: 832-***-**** Voicemail: 281-***-****

Summary

• Experienced Clinical Pharmacist with an extensive background in pharmacy benefits management (PBM) and medical affairs which includes clinical reviews, coverage determinations, patient counseling, physician support, and client facing roles for effective medication therapy management and delivery of evidence-based therapeutic recommendations.

• Currently enrolled in the Graduate Certificate Program at the University of Texas, School of Biomedical Informatics

Education:

Doctor of Pharmacy - May 1999

University of Houston College of Pharmacy

Houston, TX

Graduate Certificate in Applied Biomedical Informatics (Student) - Anticipated in 05/2021 The University of Texas Health Science Center at Houston School of Biomedical Informatics

Houston, TX

• Honor Roll Spring 2019, Fall 2019, Spring 2020

Skills

• Medication Therapy Management

• Microsoft Office including Word, PowerPoint, and Excel; Tableau (basic), MySQL and SQL (basic),

Power BI (basic)

• Basic exposure to electronic health records (EHR) including Cerner and Athena

• Messaging and Interoperability standards for Clinical data including HL7

• Consultation

• Client and management

• Counseling

• Patient care coordination

• HIPAA familiarity

• Patient care optimization

• Treatment monitoring

• Medicare Part D & Medicaid familiarity

• Healthcare decision-making background

• Delegating assignments

• Controlled drug logging

• Calculating doses

• Sales skills

• Drug therapies

• Interpreting orders

• Monthly narcotic inventories

• Legal compliance

• Drug interaction understanding

• Dispensing medicines

• Patient education and counseling

• Medication dispensing

M. Desai, Pharm.D. Curriculum vitae

Professional Experience:

June 2017 – present Staff Pharmacist

Spring Branch Pharmacy

Houston, TX

Job Description:

• Evaluate, interpret, compound, and dispense medications and other pharmaceutical supplies according to written orders/prescriptions issued by authorized prescriber. Evaluates and clarifies medication orders or prescriptions with prescribers.

• Identify, strive to prevent, assess, and resolve medication related problems to ensure a safe patient outcome.

• Promote safe, efficacious, and cost-effective medication therapy by participating in the provision and documentation of clinical pharmacy services and execution of medication utilization initiatives (e.g., IV to PO conversion program, renal dosing).

• Maintain professional competencies to meet current and future needs of the patients and customers.

• Oversee, direct, and organize technicians’ workflow in accordance with pharmacy’s policies and procedures, and operational requirements.

January 2016 – June 2016 Aetna

Clinical Pharmacist

Medicare Part D – Clinical Call Center Operations

Houston, TX (Telecommute)

Job Description:

• Improving quality of service to members and providers by providing prior authorization of formulary drugs as required by CMS regulations for Medicare Part D, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and improving claim adjudication for proper provider reimbursement

• Monitoring prescribing habits of participating CMS providers and making recommendations to physicians to improve medication regimens as appropriate

• Participating in mandatory on-call rotation when required by business needs

• Performing prospective and retrospective drug utilization reviews for various plans of Aetna Health Care Marketplace Exchange Formularies and using of clinical judgment when necessary to determine appropriate coverage determinations

• Disseminating clinical drug information and educating providers regarding the appropriate use of pharmaceutical treatment regimens

February 2013 – November 2015 Senior Clinical Pharmacist Magellan Health – Pharmacy Operations

Magellan Medicaid Administration

Houston, TX (Telecommute)

Job Description:

• Served as Senior Clinical Pharmacist, primary contact and clinical liaison for an assigned Medicaid client of approximately 1.5 million lives

• Communicated directly with Clinical Account Manager and Account Executives, and in some cases the client, to assess, investigate, and resolve difficult issues to achieve client satisfaction, which included the peer to peer

(appeals) and denial processes; also includes ensuring timely and accurate delivery of clinical reports to client and management

• Provided clinical and operational support to call center pharmacists serving as clinical virtual resource, conveying clinical updates to team as required

M. Desai, Pharm.D. Curriculum vitae

• Assisted with training new clinical staff which included serving as training resource, mentor, and coach to new hires

• Assessed training needs within team as necessary and identified and shared best practices

• Provided input to Pharmacy Manager regarding performance reviews of staff pharmacists

• Managed formulary for assigned client and assisted client in maintaining both positive and negative changes occurring at call center level.

• Collaborated with Clinical Account team and assigned client in developing treatment guidelines including assessing the impact of these guidelines at the call center operations level

• Participated in formulary development and criteria management and supported and made recommendations to client via support of the regional P&T committee of adding/removing/improving various utilization management criteria

• Maintained the non-formulary exception program consistent with contractual state guidelines including supporting drug rebate regulations and maintaining pharmaceutical reimbursement methodology for multisource products

• Developed and implemented clinical programs as agreed upon with clients and internal partners including developing criteria based on treatment guidelines

• Worked independently or with Clinical Account Manager in creating Clinical Criteria and coding for medications due to overutilization

• Assisted providers to ensure accurate dispensing and billing of products.

• Performed prospective and retrospective drug utilization reviews for various other State Medicaid programs which required cross training based on individual criteria, policies, procedures, and use of clinical judgment when necessary to determine appropriate coverage

• Disseminated clinical drug information and educated providers and staff regarding the appropriate use of pharmaceutical treatment regimens

• Provided prior authorization of formulary drugs to ensure quality of service to clients and providers

• Participated in dispute resolution of drug utilization review, assessing, and documenting patient care, and improving claim adjudication for proper provider reimbursement.

• Monitored prescribing habits of participating physicians and made recommendations to physicians to improve medication regimens as appropriate.

November 2012 – January 2013 Clinical Lead Pharmacist ACS/Xerox

Houston, TX

Job Description:

• Perform prospective and/or retrospective drug utilization review for CVS/Caremark Silverscript Medicare Part D Program

• Manage daily activities of pharmacists which include quality clinical reviews of prior authorizations and understanding and interpreting clinical criteria as defined by CVS/Caremark

• Coordinate the distribution of clinical drug information and educate providers and staff regarding the appropriate use of pharmaceutical treatment regimens

• Improve quality of service to members by providing prior-authorization of formulary drugs, developing programs to provide optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and/or improving claim adjudication for proper provider reimbursement

• Monitor prescribing habits of participating physicians and make recommendations to physicians to improve medication regimens as appropriate

• Maintain the non-formulary exception program and/or the rebate program consistent with contract, state, and/or federal guidelines

M. Desai, Pharm.D. Curriculum vitae

October 2011 – November 2012 Staff Pharmacist - PRN Spring Branch Pharmacy

Houston, TX

Job Description:

• Identify, strive to prevent, assess, and resolve medication related problems to ensure a safe patient outcome.

• Maintain professional competencies to meet current and future needs of the patients and customers.

• Oversee technicians in accordance with pharmacy’s policies and procedures. October 2011 – January 2012 Clinical Program Manager Express Scripts, Inc.

Houston, TX

Job Description:

• Served as the primary client contact for all clinical issues and initiatives

• Delivered clinical programs and services to an assigned client base which are relevant to current contractual agreements and opportunities identified with clients, in accordance with business division processes and procedures

• Upsell clinical programs and formulary related initiatives, financial formulary and clinical modeling, trend evaluation, clinical business plan development, consultation presentation, implementation and oversight, results evaluation and follow-up related to the comprehensive management of clinical programs and services

• Reviewed medication utilization issues related to formulary and drug plan design

• Provided analysis via data warehouse query or available report evaluation and communicate to clients the data- based explanations for trends and explore opportunities for improvement as necessary

• Developed, prepared, and presented clinical business plan strategy (i.e. formulary utilization) for assigned client and work in conjunction with Account Directors and Account Managers to service all needs of client

• Provided and led P&T presentations, quarterly/annual reviews, modeling report reviews

• Participated in staff meetings, committees, and departmental work groups December 2009 – October 2011 Clinical Pharmacist

Magellan Health

First Health Services

Houston, TX

Job Description:

• Perform prospective and retrospective drug utilization reviews for various State Medicaid programs.

• Disseminate clinical drug information and educate providers and staff regarding the appropriate use of pharmaceutical treatment regimens.

• Provide prior authorization of formulary drugs to ensure quality of service to clients and providers

• Participate in dispute resolution of drug utilization review, assessing and documenting patient care, and improving claim adjudication for proper provider reimbursement.

• Monitor prescribing habits of participating physicians and make recommendations to physicians to improve medication regimens as appropriate.

• Assist providers to ensure accurate dispensing and billing of products, M. Desai, Pharm.D. Curriculum vitae

August 2009 – December 2009 Clinical Science Consultant Boehringer-Ingelheim Pharmaceuticals, Inc.

Houston, TX

Job Description:

• Maintaining and utilizing expert clinical knowledge and highly effective selling skills in order to influence targeted health care professionals to appropriately increase recognition, diagnosis, and treatment rates of Chronic Obstructive Pulmonary Disease (COPD).

• Executing brand strategies to ensure a consistent company sale and marketing message.

• Establishing and maintaining effective communication, cooperation, and coordination with co-promotion partners, Boehringer-Ingelheim, Pharmaceuticals, Inc. (BIPI) field sales, Managed Markets account management and Health Economics Outcomes & Research (HEOR) counterparts as appropriate.

• Pre-call planning to meet practice needs of health care professionals (HCP’s) as well as building discussions around the opportunities to uncover COPD within the practice setting.

• Identifying thought leaders, innovators, and advocates while working with them to implement BIPI market development initiatives, working with trained speakers for given topics.

• Developing realistic plans to identify speakers and thought leaders.

• Providing presentations to HCP’s who may be associated with medical groups, community hospitals, and teaching hospitals (i.e. residency/fellowship, as well as other qualified medical venues). January 2009 – June 2009 Regional Consultant Pharmacist Texas Health & Human Services Commission

Vendor Drug Program

Houston, TX

Job Description:

• Serving as a field-based pharmacist for the Vendor Drug Program, a pharmacy benefits manager for the Medicaid Program of the State of Texas

• Planning and conducting on-site consultative visits for each contracted pharmacy provider to ensure compliance with all applicable pharmacy laws, rules, regulations, and billing practices as well as educating on the program’s policies and procedure requirements

• Serving as a liaison with the Kidney Healthcare (KHC), Children with Special Healthcare Needs (CHSCN), and Children’s Health Insurance (CHIP) programs to provide prescription claims processing and payment functions, as well as formulary management.

• Analyzing on-line claims data and preparing and interpreting management reports utilizing First Health Services for Medicaid, KHC, CHIP, and CSHCN pharmacy providers and initiating monetary recoupment for invalid reimbursements

• Providing professional and technical assistance to the Office of Inspector General (OIG), Office of the Attorney General (OAG), and other regulatory agencies when needed by referring any problems identified with compliance, fraud, drug abuse, and misappropriation of drugs

• Providing special assistance to clients, physicians, and nursing homes relating to Vendor Drug Program issues to ensure proper drug utilization and cost containment

• Submitting monthly activity report to inform management of field status

• Directing and supervising the activities of support personnel and office procedures M. Desai, Pharm.D. Curriculum vitae

• Working under the general direction of the Regional Manager with latitude to exercise independent judgment within the limits of the program’s policies and procedures and state and federal laws August 2008 – January 2009 Medical Science Liaison Hoffman La-Roche, Inc.

Houston, TX

Job Description:

• Developed a strong advocacy for Osteoporosis products through Key Opinion Leader (KOL) development by delivering quality medical education to internal and external colleagues

• Identified, built, and leveraged relationships with national, regional, and local thought leaders

• Delivered quality medical education presentations in a variety of settings and to obtain valuable feedback that can be disseminated throughout the organization (i.e. Managed Care Organizations, State Medicaid Formulary Meetings)

• Gathered and disseminated competitive intelligence from multiple sources as well as attended medical meetings to keep abreast of latest information within the therapeutic area of Women’s Health, specifically Osteoporosis.

• Completed accurate and timely administrative reports, projects, and required documentation requests November 2007 – July 2008 Clinical Science Manager Abbott Laboratories, Inc.

Houston, Texas

Job Description:

• Developed a strong advocacy for Dyslipidemia products through Key Opinion Leader (KOL) development by delivering quality medical education to internal and external colleagues.

• Identified, built, and leveraged relationships with national, regional, and local thought leaders

• Identified and developed key thought leaders for medical education and clinical research opportunities within the Dyslipidemia Franchise.

• Developed strategic thought leader plans to provide needs-based, value-added services and to improve their advocacy.

• Provided input and participated in cross-functional initiatives such as working with other departments within Abbott family.

• Participated in internal therapeutic advisory groups and project teams.

• Publication planning; slide-deck development, training initiatives.

• Provided field-based medical support to Company's clinical research programs.

• Delivered quality medical education presentations in a variety of settings and to obtain valuable feedback that can disseminated throughout the organization.

• Gathered and disseminated competitive intelligence from multiple sources as well as attend medical meetings to keep abreast of latest information within the therapeutic area of Cardiology, specifically Dyslipidemia. M. Desai, Pharm.D. Curriculum vitae

• Completed accurate and timely administrative reports, projects, and required documentation requests June 2001- November 2007 Clinical Consultant/Pharmacist CVS/Caremark

Houston, Texas

Job Description:

• Provided appropriate drug therapy consultation and presentations about Caremark patients through face to face interactions with physicians within the fields of Internal Medicine, Family Practice, Gastroenterology, and Cardiology.

• Presented and disseminated clinical data about sponsored medications using both physician and patient specific information.

• Assisted in the launch of the following medications based on clinical efficacy, safety, and cost: Nexium®, Crestor®, Cozaar®/Hyzaar®, Vytorin®, Fosamax®, Prevacid®, Seroquel®, Symbicort®, Toprol XL®, and Atacand®, and Lescol XL®.

• Moved market share for sponsored agents by converting patients to appropriate preferred drug therapy which required generating new prescriptions, discussing patient specific information on copays and their health plans, and utilizing the Preferred Drug List to educate the physicians on preferred drug selection including the services provided by Caremark Specialty Pharmacy.

• Discussed and presented relevant information pertaining to disease states (i.e. Diabetes, Hyperlipidemia, GERD, etc.) with physicians utilizing health information pieces which provide education for their patients.

• Leveraged a professional relationship with physicians to help maintain an understanding of Caremark related issues and management of their Caremark patients’ prescription benefits.

• Participated in company sponsored projects which allowed for leadership opportunities (i.e. Local Market Projects, iScribe Initiative, Silverscript Initiative, FEP Generic Initiative).

• Accomplished target physician encounter goal by scheduling and conducting face to face visits with assigned targeted physicians.

• Maintained and managed territory by documenting all calls on physician strategy including level of commitment and follow up.

• Maintained monthly budget for physician lunches and submitted weekly expense reports. February 2001 – April 2001 Customer Service Pharmacist Medco Health Solutions, Inc.

Texas Call Center

Irving, Texas

Job Description:

• Counseled patients regarding appropriate drug therapy utilization as well as physicians on the most effective treatment modalities

• Resolving drug therapy related concerns (i.e. prior authorizations)

• Helped control sponsor costs by bringing to attention of prescribers that a medication exists which is preferred by the patient’s benefit plan sponsor (formulary support) M. Desai, Pharm.D. Curriculum vitae

October 1999- February 2001 Clinical Pharmacy Manager Healix, Inc.

Houston, Texas

Job Description:

• Managed and supervised physician office-based infusion suite specializing in Infectious Diseases.

• Recommended treatment modalities to physicians for patient therapy.

• Developed & implemented new protocols for cost-effective disease state management in various infectious disease conditions

• Educated physicians and monitored patient outcomes and laboratory results.

• Dispensed medications and counseled patients on infectious disease medications that were infused on site.

• Analyzed data of financial statements and supervised nursing staff and supportive personnel Professional Certifications:

Registered Pharmacist, Texas State Board of Pharmacy Medication Therapy Management (MTM) Services – Certificate, American Pharmaceutical Association (APhA) American Medical Informatics Association (AMIA) (student member) Healthcare Information and Management Systems Society (HIMSS) (student member) Awards:

February 2004

CVS/Caremark Corporation

Accrediting Consulting Excellence (ACE) Award

August 2001 – February 2007

CVS/Caremark Corporation

Market Share Impact Award

(Nexium®, Crestor®, Atacand®, Vytorin®, Prevacid®, Fosamax®, Cozaar®, Lescol XL®) August 1996 - August 1998

Dean’s List

University of Houston College of Pharmacy

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