Prior Authorization Pharmacist

Mergima Al Arnaout

*** ******** ******** ***, ******** 06611 CT

Cell-phone: 949-***-****

*******@*****.***

Objectives

To obtain a challenging career that will enable me to practice my skills as a clinical pharmacist and have continuous opportunity for advancement in the future.

Educational Background

2002-2004

Masters degree in Clinical Pharmacy, Jordan University of Science and Technology, Jordan

1996-2001

B.S., Pharmacy, Jordan University of Science and Technology, Jordan

Licensure:

Registered Pharmacist, State of California since 2009

Registered Pharmacist, State of Connecticut since 2022

Certificate:

Pharmacist Immunization Certificate – Connecticut University School of Pharmacy – March 2021

Work Experience:

United Health Group / Optum Rx - Costa Mesa, CA: Mar 2010 - Jun 2017

Clinical team in support of prior authorization/ Decision trees team: Sep 2016-June 2017

oWorked in building medication-specific decision trees based on medication specific medical guidelines.

oWorked on transitioning specialty medications decision trees to the clinical team.

oSupported prior authorization team by providing them with medication-specific information from providers’ offices to enhance decision making and speed up the process.

Prior authorization Pharmacist: Medicare Part D & Commercial plans: Nov 2010-Sep 2016

oWorked in a very high-volume setting in the Prior Authorization department, reviewing time-sensitive Medicare Part D prescription drug claims that have been rejected at the pharmacy; utilizing Medicare Part D guidelines to determine coverage and performing necessary clinical literature search and review to guide decision making.

oWorked in collaboration with medical directors providing them summary report for cases that require their approval when a decision for coverage is unfavorable.

oReviewed commercial prior authorization cases, navigating wide range of different plans’ guidelines and formularies to determine proper coverage decision.

Appeal Pharmacist: Medicare Part D: Mar 2010-May 2010

oWorked as part of Appeals and Grievances department, reviewed Medicare Part D cases that were denied at the prior authorization level; utilized Medicare Part D guidelines to determine coverage; performed extensive and in-depth clinical literature search; comprehensive final case report submission to an internal database, and worked in collaboration with onsite medical director.

CVS Pharmacy - South Orange County, CA: Nov 2006-Apr 2010

Retail Pharmacist Oct 2009 – Apr 2010

Processed, compounded and prepared prescriptions. Counseled patients on their medications. Processed insurance rejections and claims.

Intern Pharmacist Nov 2006– Oct 2009

Typed and filled prescriptions, processed insurance rejections, counseled patients on their medications, and interacted with physicians’ offices to process prescriptions.

King Hussein Cancer Center http://www.khcc.jo/ - Amman, Jordan: Jan 2005– Sep 2005

Hospital Pharmacist

●Worked in the oncology pharmacy. Prepared IV admixtures and IV fluids and electrolytes.

●Worked on interdisciplinary TPN team. Performed calculations and supervised technicians preparing TPN bags.

●Worked in the outpatient pharmacy, filled prescriptions for discharged and clinics’ patients

Queen Pharmacy - Damascus, Syria: Sep 2001-Aug 2002

Community retail pharmacist

●Processed prescriptions in a community pharmacy and counseled patients on their in-home medications.

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