Prior Authorization Customer Service
Resume:
BRIAN BLADES
**** ********* *****, ************, ******* 32216
E-mail: ***********@***.***
SUMMARY OF QUALIFICATIONS
• A high-energy, multi-tasking State of Florida-registered Pharmacist with a Doctorate of Pharmacy degree and a Bachelor of Business Administration (BBA) degree plus more than 3 years of hands-on practical experience that includes completion of multiple Internships and Clinic Rotations.
• Thoroughly knowledgeable in the safety protocols for dispensing controlled substances (Schedule II-V) including relevant DEA regulations and guidelines for inventory management, logging and recordkeeping; strong analytical and problem-solving abilities; well-organized and detail oriented.
• Exceptional interpersonal and oral/written communications skills for coordinating with a variety of healthcare professionals and pharmacy personnel and delivering highest quality customer service.
• Computer literate including proficiency in Microsoft Office Suite as well as Cerner, Citrix, PDX Classic, PDX Enterprise, AS400, McKesson, ImageNow, Epic, Oasis, AllScripts and DPAS applications. PROFESSIONAL EXPERIENCE
10/20 - THE JUDGE GROUP (under contract to UNITED HEALTHCARE), Jacksonville, Florida 04/21 Prior Authorization Pharmacist – Contractor Position
• Reviewed prior authorization requests for Medicare Part D standard and specialty drugs according to published policies and procedures, CMS regulatory and compliance requirements, and applicable clinical criteria.
• Performed coverage determination for various types of prior authorization reviews, including step therapy, tier exception, quantity limit, B vs D, and non-formulary exception requests.
• Outreached and consulted with providers and medical staff in order to obtain necessary clinical information for case decisioning purposes, and to discuss suitable formulary alternatives when requested.
• Conducted periodic reviews of clinical literature and various drug compendia in order to provide support for coverage determinations.
• Consistently met all company quality standards and individual metrics as required for the position of PA pharmacist.
10/18 - HEALTHCARE SUPPORT (under contract to AETNA), Jacksonville, Florida 04/20 Prior Authorization Pharmacist – Contractor Position
• Reviewed Medicare Part D prior authorization cases for proper determination according to plan specific criteria, CMS regulatory and compliance requirements, and applicable clinical criteria.
• Performed coverage determination for various types of prior authorization reviews, including step therapy, tier exception, quantity limit, and non-formulary exception requests.
• Outreached and consulted with providers and medical staff in order to obtain necessary clinical information for case decisioning purposes, and to discuss suitable formulary alternatives when requested.
• Conducted periodic reviews of clinical literature and various drug compendia in order to provide support for coverage determinations.
• Consistently met and exceeded all company quality standards and individual metrics as required for the position of PA pharmacist.
Résumé of Brian Blades, Page 2 of 3 Pages
12/17 - THE JUDGE GROUP (under contract to UNITED HEALTHCARE), Jacksonville, Florida 04/18 Prior Authorization Pharmacist – Contractor Position
• Reviewed prior authorization requests for commercial plans according to published policies and procedures, applicable clinical criteria, and regulatory and compliance requirements.
• Rendered coverage determinations based on specific plan criteria, including medical necessity, step therapy, and non-formulary exception requests.
• Formulated individual correspondence letters of denial or acceptance for both plan participants and providers.
• Consulted with providers and medical staff in order to obtain any clinical information necessary for case decisioning purposes.
• Reviewed and discussed clinical regimens, guidelines, and suitable formulary alternatives with providers and other medical staff.
• Met and exceeded all quality standards, customer performance guarantees, and company metrics as required for the position of PA pharmacist.
03/16 - OMNICARE PHARMACY, Jacksonville, Florida
01/17 Dispensing Pharmacist – LTC
• Successfully performed the full range of traditional responsibilities of a dispensing pharmacist, meeting or exceeding all work flow demands, production quotas and deadlines.
• Established and maintained an effective liaison among a large population of physicians, nurses and clinical personnel counseling on prescriptions and OTC medications; took prescription orders from physicians and nurse practitioners, monitoring for completeness and accuracy including refill labels.
• Maintained inventory of Schedule II-V drugs and closely monitored ordering, handling, receiving, documentation and storage of all controlled substances ensuring regulatory compliance with relevant DEA policies and guidelines.
• Double-checked all prescription orders for content and accuracy of drug packaging and labeling; adjusted patient IV medication dosing based on lab values and pharmacokinetic data.
• Conducted daily oversight of all pharmacy operations to ensure therapeutic appropriateness, accuracy and drug interactions on all prescription orders. 05/13 - TARGET STORES, Jacksonville Beach, Florida 07/15 Corporate Pharmacy Intern
• Performed broad range of pharmaceutical functions including processing and dispensing prescription medications, transcribing new and refill prescriptions via telephone and voice mail systems, conducting cycle counts and medication ordering, and maintaining proper inventory levels.
• When appropriate, provided counseling to patients on topics such as diabetes, heart disease and immunizations via on-site clinic.
05/12 - SMART PHARMACY, Jacksonville, Florida
11/12 Independent Compounding Pharmacy Intern
• Under supervision, prepared various pharmaceutical compounds including hormone creams, pain relief creams, capsules, and other proprietary preparations.
• Monitored inventory levels and entered orders and new compound preparations into computer system, and helped with overflow from retail area by logging and filling prescriptions. APPE PHARMACY PRACTICE ROTATIONS
02/15 – 03/15 Neurology – Baptist Medical Center Downtown Dr. Kathleen Baldwin, MA, Pharm DF, BCPS
Résumé of Brian Blades, Page 3 of 3 Pages
01/15 – 02/15 Cardiology – Baptist Medical Center Downtown Dr. Lori Fiallo, Pharm D, BCPS
12/14 – 01/14 Hospital Practice – St. Vincent’s Hospital – Southside Dr. Katrie Shell, Pharm D
11/14 – 12/14 Community Pharmacy Practice – Publix Pharmacy Dr. Craig Brubaker, Pharm D, BCPS
10/14 – 11/14 Inpatient Psychiatry – Baptist Medical Center Downtown Dr. Naomi House, Pharm D, BCPP
09/14 – 10/14 Critical Care – Baptist Medical Center South Dr. Cynthia Budzinski, Pharm D, BCPS
08/14 – 09/14 Pediatric Endocrinology – Florida Diabetes Camp Gary Cornwell, Camp Director
05/14 – 07/14 Internal Medicine – St. Vincent’s Hospital – Southside Dr. Quovadis Epps, Pharm D, BCPS, MS
03/14 – 05/14 Ambulatory Care/MTM/Geriatrics
Anne Cordes, Pharm D, Consultant Pharmacist
EDUCATION & PROFESSIONAL LICENSURE
UNIVERSITY OF FLORIDA, Jacksonville, Florida
University College of Pharmacy
Doctorate of Pharmacy
Degree conferred 2015
FLORIDA STATE COLLEGE AT JACKSONVILLE
Pharmacy Prerequisite Courses (4.0 GPA)
2009-2011
UNIVERSITY OF NORTH FLORIDA, Jacksonville, Florida Bachelor of Business Administration (BBA)
Degree conferred 2002
HONORS & AWARDS
Academic Excellence Award in General Chemistry I & II, and Organic Chemistry I & II Achieved President’s List multiple semesters in Science & Math prerequisites
Contact this candidate