Prior Authorization Customer Service

Mobile: +1-571-***-**** ***********@*****.***

linkedin.com/in/ Reem Alhaj

SUMMARY

With a Doctor of Pharmacy degree and extensive experience, I have been honored to support major pharmaceutical companies and hospitals for over a decade. My expertise in outpatient and retail pharmacy management, drug therapies, and exceptional customer service has enabled me to make a meaningful difference in countless lives. I am passionate about patient education, advocacy, and medication safety, and my specialized knowledge in Prior Authorization, formulary management, and utilization review has only strengthened my commitment to serving others.

SPECIALIST & PERSONAL SKILLS

Drug utilization review (DUR) and prior authorizations

Perform prior authorization reviews for medication coverage, ensuring adherence to clinical guidelines and formulary requirements.

Evaluate medical necessity and appropriateness of prescribed medications based on patient-specific information and clinical criteria.

Collaborate with healthcare providers to obtain additional clinical documentation and information for the prior authorization process.

Communicate with insurance providers to resolve coverage issues, clarify clinical justifications, and ensure timely approval.

Excellent research, communication, and computer skills (Epic System & health connect)

Great mathematical and excellent analytical skills, problem-solving skills

Extensive knowledge of medicines, compounds, and their dosages

Proficient in conducting drug regimen reviews and therapeutic interventions

Advanced knowledge of medical terminologies and pharmacotherapy

Knowledge of planning effective drug therapies

Understanding of state and federal laws and regulations

Proactive, self-confident, initiative, professionalism, and respect for cultural diversity

WORK EXPERIENCE

Pharmacist Ascension Healthcare Apr 2023-Present

Reads the physicians' orders and delivers medications as required, keeps accurate up-to-date records and patient profiles to ensure accuracy

Conduct medication therapy management interventions to optimize therapy, improve patient outcomes, and reduce healthcare costs.

Recommend formulary alternatives when appropriate.

Compound and dispense medications for accurate delivery to patients.

Provide drug information and education to medical staff and patients.

Communicate with physicians and other clinicians as necessary to facilitate care.

assist in the preparation, maintenance, and dispensing of medications and supplies and inventory management.

Assist with training by serving as a preceptor for pharmacy students.

Provide patient counseling efficiently and effectively when required.

Pharmacist Manager CVS Pharmacy Jun 2022- Dec 2022

Supervise a team of 9 pharmacy staff members.

Hire and train new pharmacy personnel.

Provide guidance and mentoring to staff members who wish to obtain further qualifications.

Liaise with physicians and patients to ensure proper dosage and lack of adverse drug interactions.

Counsel patients on the proper use of medication and potential side effects.

Fill and dispense prescriptions.

Increase sales and customer satisfaction by optimizing the filling process to reduce wait times.

Promote pharmacy services to patients and medical providers.

Create an information campaign about the availability of new medication types and immunizations.

Manage inventory.

Ensure compliance with all applicable laws and regulations.

Prepare for insurance audit and interface with auditors.

Clinical Oncology Pharmacist Teleperformance-UHC Optum 2021-2022

Monitor utilization patterns and trends to identify opportunities for improvement and cost-saving strategies.

C Support utilization review determinations for cancer populations, and broader case and disease management teams to achieve optimal clinical outcomes

Post the Drug Formulary and prior authorization criteria.

Provide clinical guidance in the creation, implementation and refinement of an Oncology utilization management solution

Serve as a subject matter expert in evidence-based medical guidelines and help ensure all clinically relevant policies and processes are informed by the best available evidence

Dosage-based reviews

Preservice Chemotherapy Reviews

Post-auto-approval documentation audits

Initial Onboarding and Ongoing Oncology Training

Lead MD Clinical Audits

Clinical Education

NCCN Digitization

Evaluate clinical and other data (e.g., quality metrics, claims & health record data, utilization data) to identify opportunities for improvement of clinical care and processes.

contribute to quality improvement initiatives and participate in pharmacy department projects.

AMBULATORY CARE PHARMACIST KAISER PERMANENTE 2015- 2022

Manage ancillary staff in fulfilling more than 1500 prescriptions daily. Consult with physicians and patients about medication dosage, drug interactions, medical equipment, disease management and potential side effects of prescription and OTC medications.

Dispense and compound prescriptions, and maintain accurate patient records, dosing information and directions for use. Interact with HMOs and other insurance providers concerning billing/reimbursement issues. Prior Authorization. Keep abreast of new developments within the pharmaceutical industry.

Provides advice and consultation to patients regarding side effects of drug interactions, specific storage requirement, and complete directions for use, and verify patient’s allergy information

Monitors designated patients' compliance, adherence, and response to drug therapy to improve individual patient outcomes

Routinely communicates with providers to influence the use of formulary medications in compliance with clinical protocols, target drug initiatives, and pre-authorized therapeutic substitutions

Documents all clinical interventions using approved forms

Review pharmacy prior authorization requests for medical necessity, using best practices and quality standards.

Demonstrates proficiency in operating automated systems for prescription order entry, patient profile review, or retrieval of clinical or statistical data

Demonstrate proficiency in operating automated systems for prescription order entry, patient profile review, or retrieval of clinical statistical data.

Serves as a liaison to assigned clinical care team as demonstrated by problem-solving skills on medication-related issues, input on education matters relating to medications, and fostering interdepartmental coordination on pharmaceutical care initiatives

Maintains professional competency through attendance and participation in clinical team meetings and ACPE-accredited continuing education programs

Assists in the training and education of pharmacy students and technicians

Participates in departmental quality improvement initiatives and contributes to team or departmental projects directed toward the achievement of improved service efficiency and patient outcomes

PHARMACY INTERN KAISER PERMANENTE 2012-2014

Processed and dispensed medication transferred prescriptions and Maintained inventory and supplies in the assigned pharmacy service areas

Return phone calls in a timely and professional manner; keep in contact with doctors and hospitals regarding patients when necessary.

Orders and delivers drug supplies for various patient care wards of the healthcare organization

Assist pharmacists on orders and delivers medications as required, keep accurate up-to-date records and patient profiles to ensure accuracy.

HOSPITAL PHARMACIST KHARTOUM HOSPITAL 2008-2012

Prepares prescriptions for patients under the guidance of healthcare professionals

Provides suggestions on therapeutic therapies like oncology, intravenous nutrition & mental health

Conducts various research on the prevention and treatment of tropical diseases

Assists pharmacist technicians in filling prescriptions, counseling patients, and contacting other healthcare institutions when required

Maintains and stocks pharmacy products and checks their expiry dates

Records patients' drug therapies in computers and monitors negative drug interactions, if any

Fulfill clinical function and provide pharmaceutical services to pediatrics, adults, and geriatric patients

Prepared and supervised all sterile IV drug product compounding

EDUCATION, LICENSES & CERTIFICATIONS

Doctor of Pharmacy Howard University, Washington, DC 2018

Bachelor of Pharmacy University of Science & Technology - Sudan 2006

Northern America Pharmacist License USA, Licensed in Washington, D.C. 2015

Pharmacy-Based Immunization Delivery APhA 2018

CPR Certification American Heart Association 2018

HIPA certification

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