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Clinical Pharmacist Prior Authorization

Location:
Newton Centre, MA
Posted:
December 12, 2022

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Resume:

DAVID B. GOLDWATER, Pharm B.S. R.Ph.

*** ********* **** * Auburndale, MA 02466 * adt0qb@r.postjobfree.com * 617-***-**** (mobile)

Current wireless connection speed: Download 85 Mbps _Upload 84 Mbps

PROFESSIONAL SUMMARY

Clinical Pharmacist with over fifteen (18) years of direct patient centered medication management experience gained in Long Term Care. HMO prior authorization experience. Formulary development. Policies and Procedures.

RECENT WORK EXPERIENCE

INDEPENDENT CONSULTANT Aug 2015 – Present

Concierge Pharmacist:

Providing private medication management services for MTM Medicare-eligible and private-pay patients.

HARVARD PILGRIM HEALTHCARE, Quincy, MA Jan 2020– April 2020

Clinical Pharmacist Consultant

Hired by the Medical Policy Division to update, review, verify and authenticate all their currently approved drug authorization criteria and policies.

Short term intensive contract.

Presented these verified policies at three Harvard Pilgrim Medical Director Review Board meetings for final discussion and approval.

OMNICARE PHARMACY, Peabody, MA Dec 2013 – Mar 2015

Clinical Pharmacist: (Position eliminated by corporate reorganization due to business losses.)

Performed Medicare MTM (Medication Therapy Management) interviews directly with individual patients and family members in the long-term care setting and then submitted required reports to individual patients and Medicare.

Performed transitional care medication reconciliation on all new and re-admitted patients to identify and resolve any issues to prevent re-hospitalization.

Daily performance of on-site medication management reviews on patients allocated to clinical practice.

Provided formal education to patient care providers to optimize prescribing practices and improve safety and efficacy of prescribing.

Applied medication management strategies in several therapeutic areas including but not limited to warfarin management and most major disease states.

Communicated directly and in writing with Physicians, Nurse Practitioners and Nurses regarding specific medication issues arising from the individual patient reviews with high response rate, as documented during subsequent monthly facility visits.

WORK EXPERIENCE

ALL CARE PHARMACY, Worcester, MA May 2013 – Oct 2013

Advisory Expert:

Functioned in a temporary advisory capacity to support their newly expanded business focus into Long Term Care.

Wrote Policies and Procedures for the pharmacy consultant role regarding state and federal regulations.

Advised upper management on Massachusetts and Federal, Long Term Care regulations and standards of clinical medication management and medication therapy management (MTM) practice.

CARE ONE PHARMACY OF MASS LLC, Marlborough, MA Oct 2005 – Jan 2013

Clinical Pharmacist and Educational Resource Specialist:

Selected to join this start-up pharmacy endeavor to service its corporate owned Massachusetts LTC facilities, previously serviced by local vendors based on my broad clinical and supervisory experience.

Performed daily on-site medication management reviews on patients allocated to clinical practice in nine facilities.

Performed direct patient assessment and interaction with specific patients regarding pain control, and those being treated for Parkinson’s. Specifically observed behavior of dementia patients and performed assessment of potential tardive dyskinesia for those patients on antipsychotic drugs.

Ad hoc dispensing role in operations involving entering and checking orders, supervising technicians, and oversight of TPN and antibiotic IV preparation.

Formally collaborated on individual patient care with the Nurses from our Care-One Hospice Subsidiary.

Communicated directly in person and in writing with Physicians, Nurses, and Nurse Practitioners regarding specific medication management recommendations arising from the individual patient reviews, and then followed up on outcomes of these suggestions during subsequent facility visits.

Wrote and directed Interdisciplinary team communications on best practice strategies to improve safety and efficacy of physician ordering practices by focusing on, avoiding med errors and influence positive medication outcomes.

Created and applied innovative academic detailing approaches for disseminating relevant post-marketing drug surveillance information and protocol implementation to the multi-disciplinary team of physicians, nurses, dietitians, and other relevant members.

Performed medication utilization analysis to identify inappropriate patterns of use in targeted therapeutic areas and then created and implemented quality improvement initiatives to address, measure and improve patient outcomes.

BMC HEALTH-NET PLAN, Boston, MA Oct 2004 – Oct 2005

Prior Authorization Clinical Pharmacist:

Created and maintained Internet and intranet prior authorization criteria to ensure that all information related to pharmacy benefits were kept current with P&T decisions

Responsible for planning, development, and maintenance of the plan’s formulary.

Presented and analyzed utilization data quarterly to the Health Plan’s P&T Committee.

Performed and managed the review, of pharmacy prior authorizations, and appeals.

Acted as a resource internally and externally to communicate benefit coverage to all participating clinicians.

Collaborated with the pharmacy benefit manager(PBM) and specialty pharmacies to assure all benefit decisions were cost effective and appropriately administered.

Participated in weekly patient care management committees with clinicians and clinical support staff.

Developed medication education campaigns by writing and distributing materials to patients as needed.

STAT-CARE PHARMACY SERVICES. North Grafton, MA. Sept 2002 – Sept 2004

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Clinical Pharmacy Manager:

Functioned as the primary clinical strategist and regulatory resource for the clinical consultant and operation teams.

Developed clinical education and in-service materials for use by the clinical pharmacy team in their long- term care facilities.

Managed a clinical team of five clinical pharmacists.

Developed and directed clinical strategic goals and oversight for a pharmacy servicing a total of 4,500 beds, with reporting responsibility for clinical services to the Executive Director of operations.

CURRENT LICENSES

Massachusetts Pharmacy license # PH18714

EDUCATION &TRAINING

Pharm B.S. Massachusetts College of Pharmacy, Boston, Massachusetts.

Fellowship in Disease State Management, ( The Education Foundation of the American Society of Consultant Pharmacists)



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