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Customer Service Prior Authorization

Location:
Carol Stream, IL
Salary:
130000
Posted:
August 11, 2023

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Resume:

JEETENDRA PATEL

License# *********, Exp **/**/***4

SUMMARY:

Innovative and collaborative pharmacist with management/director experience in managed care

(Medicare, ASO, Commercial lines of business). Experience in building a pharmacy and utilization management department at start-up health plan within an integrated hospital system, as well as experience in pharmacy benefit manager operations.

EDUCATION:

MBA: Business Administration University of Michigan - Flint, MI

Dean's List year of 1999 Awarded for GPA 4.5 out of 5

Scholarship Recipient Rite-Aid retail Pharmacy Chain

05/1996 Pharm-D: Pharmacy

Massachusetts University, Collage of Pharmacy - Boston, MA Class President

Awarded Honor Roll Keppa Psi Brotherhood

Indian Pharmacist Organization Pharmacy Times

Hospital Pharmacist

SKILLS

Prior Authorization

Microsoft Office (10+ years)

Supervising Experience

Clinical Pharmacy Experience

Performance Management

Aseptic Technique

Insurance Verification

Utilization management

Medicare

Communication skills

Managed Care

Employee Orientation

Management

Leadership

Customer service

Windows

Microsoft Word

WORK HISTORY:

Vista Hospital and Health – Waukegan, IL Apr’22 to Current

Inpatient Clinical Pharmacist

Medication verification, IV preparation, Compounding, dosing, recommending, filling, reviewing chart and checking interactions, allergy status, filling and checking carts for ICU, ER, infants & mothers, monitoring patient's medications. Maintain narcotic inventory and records usage of all substances and pharmaceuticals within the pharmacy.

Review and complete requests requiring prior authorizations.

Advised physicians on how to properly dose medications.

Trained pharmacy residents and interns on clinical care and medication dispensing. Depending upon the assignment, may prepare chemotherapy and varieties of IV solutions.

Supervise or coordinate the activities of pharmacy technicians who are engaged in the preparation, labeling, and delivery of oral/IV medications.

Maintain professional and working relationships with medical and nursing staff Maintain pharmaceutical knowledge by attending educational meetings and services.

Collaborate with co-workers and other health care professionals to require and review.

Prescriptions to determine appropriate medication therapy.

Utilize sound judgment to make appropriate decisions in the best interests of patients and the hospital protocol.

Providing consultation to and answers inquiries from patients, families, and physicians

Assists the physicians and nursing staff in development of therapeutic drug plans for patients.

Attending weekly and monthly staff meetings and other meetings where critical discussions take place for patients' well-being.

Interpreted prescriptions from healthcare providers to properly dispense medications and health products.

Educated patients on possible drug interactions, potential side effects, and optimal methods of administration.

Partnered with physicians and other members of healthcare team to optimize.

Cardinal Health – Westmont, IL Jun’21 to Apr’22

Clinical Pharmacist

Participates in development and oversees the implementation of targeted clinical programs.

Partnered with physicians and other members of healthcare team to optimize patient care through effective use of medications.,

Provide consultations and answer inquiries from hospital nurses and physicians regarding medications and their usage.

Advised physicians on how to properly dose medications.

Educated prescribers on Prior Authorization (PA) processes for medications that needed review and approval from the health plan before they were covered.

Coordinate Pharmacy in-service programs, ensures ongoing communication among care staff members, interprets components of care plan, communication technology.

Interpreted prescriptions from healthcare providers to properly dispense medications and health products.

Overseeing client services and ensuring compliance with established program standards and service delivery objectives

Recruited, trained, and guided pharmacist assistant and junior pharmacists improving their overall performance.

Utilize sound judgment to make appropriate decisions in the best interest of the patient and the hospital protocol.

Evaluated patient histories to assess medication compliance and spot issues such as doctor shopping or excessive usage.

Advised patients on medication side effects and contraindications and explained proper administration.

Forum Extended Healthcare Services – Chicago, IL Jul’08 to Jun’21

Pharmacist

Work is computer based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information.

Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases.

Provided customer service to nursing staff, residents, administrators, physicians, and other healthcare professionals at long term care facilities.

Reviewed prescription to confirm appropriate selection of drug, dose and check for interactions with other medications.

Performed pharmacokinetic calculations, including TPN, PCA orders, and provided recommendations when consulted by a physician at a long-term care facility.

Reported adverse drug events to comply with regulatory policies and procedures. Interpreted prescription orders, dispensed medications, and counseled patients on drugs.

Verified all medication orders against physician orders and/or prescriptions.

Communicated issues and reactions to specific medications to intercept potential errors.

Performed final checks of labeled medications to ensure accuracy and adherence to client protocols.

Reviewed and evaluated orders for non-formulary to identify generic alternatives. Maintained perpetual inventory of all C-II medications.

Prepared medications in blister packs to provide safe and convenient way to take prescribed medication.

Making sure STAT and hospice orders are prioritized so that patients receive medications on time.

Remained knowledgeable about health insurance and other third-party payment programs to facilitate purchases.



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