Pharmacy Manager

Shelly Carter, BSPharm, AAHIVP, BCMTMS

New York, NY 11230 347-***-**** *************@*****.*** linkedin.com/in/shellycarter1 PRIOR AUTHORIZATION CLINICAL PHARMACIST

PHARMACY BENEFITS MANAGEMENT (PBM) QUALITY & COST CONTROL MEASURES Committed pharmacy leader with solid clinical acumen and managed care pharmacy/(PBM) experience. Out-of-the-box critical thinker with demonstrated expertise in medication therapy management and improved drug utilization. Excellent oral, written, and interpersonal communication skills able to work efficiently and adapt to meet dynamic operational goals. KEY STRENGTHS

Medication Therapy Mgmt (MTM)

Health Outcomes

Drug Literature Evaluation

Medication Adherence

Evidence-based Medicine

Clinical Guidelines

Drug Utilization Review (DUR)

Third-party Billing

Medicaid & Medicare Programs

Project Management

Prior Authorizations

Policy Development

Completed 1100+ MTM’s overall in 2019; Completed 1120+ prior authorizations at Emblem Health from January to July 2020. Won all three Healthfirst 1st prize MTM completion contests in Dec 2019 for total number of CMRs completed. RELEVANT EXPERIENCE

Emblem Health, New York, NY (Dec 2019 to Present)

One of the nation’s largest not-for-profit health insurers serving 3M+ people in the New York tri-state area SENIOR CLINICAL PHARMACY SPECIALIST

• Provide management and specialty clinical pharmacy services, including appropriate drug therapy recommendations and prior authorization approvals to Emblem Health participating providers.

• Collaborate with practitioners to make clinical decisions that enhance patient care quality and contain health care costs.

• Review prior authorization requests for Medicare, NYS Medicaid, Commercial, and Exchange lines of business. Healthfirst (United Staffing Solution), New York, NY (Aug 2018 to Dec 2019) New York’s largest not-for-profit health insurer with 40K providers and 1.5M members UTILIZATION MANAGEMENT PHARMACIST MTM PHARMACIST PHARMACY MANAGER Medication Therapy & Disease State Management

Completed 45-63 MTM reviews per week consistently exceeding quotas of 25 per week

• Provided medication therapy management via examination of electronic medical records using the Sinfonia RX platform.

• Performed comprehensive medication reviews (CMRs) communicating telephonically with members and providers to discuss medications.

• Reviewed and optimized members’ medication therapy by applying evidence-based medicine and national guidelines to recommendations submitted to healthcare providers.

• Analyzed and reviewed medication lists for potential patient safety problems (e.g., drug interactions, suboptimal medication regimens, etc.)

• Contacted and coached members identified as not achieving clinical goals of therapy, providing specific measures related to diabetes and cholesterol (SUPD, SPC).

Challenge/Action/Result: Suggested an auto-dialer to contact hard to reach members.

Significantly increased MTM completion rate during MTM cold calling by contacting hard to reach members.

Exceeded weekly goal for internal MTM calls and completed CMRs outpacing an outsourced vendor for the same tasks

Achieved pharmacy benefit management 4-star rating—upgraded from 3-star due to increased CMR completion

Influenced the addition of a new Medication Adherence Team based on successful results Cost Containment

• Reviewed prior authorization requests for medications requested under the medical benefit via TruCare platform.

• Developed clinical and medical policies for provider administered medications.

• Work directly with prescribing physicians and medical directors to discuss clinical rationale for reviewed decisions.

• Ensured all clinical criteria complied with Center of Medicare & Medicare Services (CMS) and the New York State Department of Health (NYSDOH).

Shelly Carter, BSPharm, AAHIVP, BCMTMS

Shelly Carter, BSPharm, AAHIVP, BCMTMS P a g e 2

• Researched drug information as needed; ensured prior authorization reviews were completed within CMS and NYSDOH required timeframes.

• Completed robust professional development to maintain drug knowledge and disease state understanding for application to prior authorization reviews. Operations Management

• Oversaw pharmacy technicians on the MedConnect team; supervised 22 pharmacy technicians (11 in New York and 11 in Orlando).

• Conducted outreach calls to Medicare members to ensure adherence to medication regimens.

• Called providers, and/or pharmacies to coordinate prescription fills when the member has exhausted refills.

• Oversaw calls to Medicare members addressing any clinical questions a technician was not allowed to address.

• Completed peer-to-peer reviews for pharmacy technicians. Rockaway Pharmacy, Rockaway, NJ (Jan 2013 to Oct 2018) SUPERVISING PHARMACIST

Accurately dispensed medications for inpatient and outpatient pharmacies. Conducted drug utilization reviews and final quality assurance checks to ensure accuracy and appropriateness of all filled prescriptions. Clinical Impact

• Monitored patient profiles to identify and prevent medication-related issues (e.g., contraindications, drug interactions.)

• Served as subject matter expert for physicians, nurses, and other healthcare professionals by providing drug information and appropriate therapeutic recommendations.

• Counseled patients on prescriptions and the selection of OTC medications, herbal supplements, and vitamins. Operations Impact

• Expanded prescription volume and clientele 150% from 70 to 170-180 scripts daily.

• Coordinated Medicare billing and accreditation requirements/compliance.

• Completed monthly audits and submitted monthly control reports. B & M Family Pharmacy, Brooklyn, NY (Aug 2011 to Dec 2012) SUPERVISING PHARMACIST

Accurately processed prescriptions, oversaw pharmacy, and directed technical staff. Maintained confidential information and ensured compliance with pharmacy policies and procedures. Consulted with patients and providers regarding appropriate medication use for safe and effective care.

• Resolved prior authorization and other third-party insurance issues recommending formulary alternatives as needed to decrease cost of care for patients.

• Served as a trusted drug resource for patients, physicians, nurses, and other healthcare professionals.

• Educated patients and family members on proper use, side effects, and drug interactions to increase medication adherence. EDUCATION & CREDENTIALS

Shenandoah University, Doctor of Pharmacy (PharmD) Candidate (May 2022) Long Island University, Brooklyn, NY - Bachelor of Science (BS) in Pharmacy Borough of Manhattan Community College, New York, NY - Associate in Science (AS) Human Services Board Certified Medication Therapy Management Specialist (BCMTMS) - National Board of Medication Therapy Management HIV Pharmacist (AAHIVP) Certification - American Academy of HIV Medicine Patient-Centered Diabetes Care Certificate - American Pharmacist Association (APhA) Patient-Based Immunization Delivery Certificate - American Pharmacist Association (APhA) Medication Therapy Medication (MTM) Certificate - PowerPak Registered Pharmacist: New York and Florida

IT SNAPSHOT: Microsoft Office (Microsoft Word, Excel, PowerPoint, Outlook), PDX, Opus, RX Prime, Connexus, Michromerchant, Salesforce, TruCare, SinfoniaRX, IB Business Manager PROFESSIONAL ENDORSEMENT

“Thank you for coming out of

the MTM gate swinging!”

“I cannot thank you enough

for the support you have given

our members through MTM.

Please continue doing what

you do.”

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Valentino DiPaola, RPh

Pharmacy Manager, Quality

Healthfirst

Contact this candidate