Clinical Pharmacist Prior Authorization
Resume:
LaTarshia Y. Boone, Pharm D
***** ******** ***** **** ● Raleigh, NC 27614
********@***.***
QUALIFICATION SUMMARY
Clinical Pharmacist possessing over 20 years of broad healthcare experience including hospital based, retail, government and the insurance setting.
RECENT PROFESSIONAL EXPERIENCE
Anthem, Inc. Norfolk, VA (Work- at- Home)
Clinical Pharmacist 12/14 to present
Provides evaluation of member Rx needs and therapies through review of medication history to determine if medications are appropriate
Assesses member compliance with plan through direct contact with members and their physicians
Ensures that members understand appropriate use of current prescriptions
Reviews medications with physicians when therapies do not meet national standards and counsels physicians around alternative medications.
Ensures that members understand appropriate use of current prescriptions
Serves as a resource to the clinical team in disease management and other clinical areas.
Performs clinical review of initial coverage determinations and reconsiderations (appeals) on Non-Formulary, Prior Authorization, Quantity Limit, and Step Therapy requests using client- specific guidelines
Provides support to ancillary providers (physicians, nurses, network pharmacists, etc.) as required
Utilizes client-specific regulations to perform clinical reviews and assessments
Collaborates with Medical Directors for peer-to-peer reviews as needed
Conducts peer-to-peer reviews with physicians who disagree with denial decisions CVS/Caremark for ACS Government Solutions Raleigh, NC Clinical Pharmacist (Contract) 01/12 to 12/14
Performed clinical review of initial coverage determinations and re-determinations (appeals) on Non-Formulary, Prior Authorization, Quantity Limit, Step Therapy, and Tier Exception requests using guidelines developed by the Pharmacy and Therapeutics (P&T) Committee
Provided support to ancillary providers (physicians, nurses, network pharmacists, etc.) as required
Performed supervisory responsibilities of Clinical Services staff and workflow as assigned by the Manager of Clinical Services
Utilized Medicare Part D and CMS regulations to perform clinical reviews and assessments Humana, Inc. Raleigh, NC (Work-At-Home)
RxMentor Pharmacist for Medication Therapy Management Division 06/08 to 08/10
Provided medication therapy management (MTM) to eligible members through one-on-one telephonic consultations
Served as trusted advisor to members
Performed comprehensive medication reviews
Applied clinical knowledge to resolve medication related problems
Ensured optimal medication safety
Collaborated and engaged in discussions with other health care professionals to provide complete pharmaceutical care and therapy management
ACS Government Healthcare Solutions Raleigh, NC & Atlanta, GA Clinical Pharmacy Director/Medication Therapy Management Pharmacist/Clinical Relations Manager/Therapeutic Consultation Program Manager 08/00 to 05/08
Performed telephonic Medication Therapy Management (MTM) consultations addressing education, adherence, cost savings opportunities and safety with patients and providers
Reviewed drug prior authorization requests as needed by client and/or support staff
Reviewed and updated tables required for correct claims adjudication
Advised appropriate client representative(s) and the Drug Utilization Review (DUR) Board as determined and requested by client on pharmacy drug utilization review (DUR) issues
Provided clinical direction and consultation to a variety of client types including Medicaid, HMO Employer Group, Workers' compensation, and others
Assisted in the development of formulary and drug benefit design
Performed utilization reviews of client utilization trends and provided solutions to insure appropriate utilization from both quality of care and cost-efficient perspectives
Conducted and/or participated in client's DUR, P&T Committee meetings, or other meetings to present pharmacy and clinical information required or requested by the client
Participated in the development of internal clinical programs
Assisted in the procurement of new business as required
Proactively presented clients with solutions to potential areas for clinical or cost concern
Managed daily operations for direct report pharmacists EDUCATION
Doctor of Pharmacy May 1995
Mercer University Atlanta, GA
Bachelor of Science May 1990
NC Central University Durham, NC
CERTIFICATIONS
Medication Therapy Management Certification 2007-2010 LICENSURES
North Carolina #17149 Georgia #RPH018303
REFERENCES AVAILABLE UPON REQUEST
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