Quality Assurance Patient Care

Maryanne Guertin

Saunderstown, RI ***** **********@*****.*** 619-***-****

Specializes in: Patient-Focused Treatment, Data-Based Strategies, and Team Leadership

Detail-oriented, dynamic leader with extensive pharmacy experience in hospitals, home infusion, and managed care including compassionate patient care, team leadership and training, and ensuring compliance with regulations and GCP. Collaborative communicator demonstrating ability to partner with patients and interdisciplinary teams to align priorities, develop comprehensive treatment plans, and achieve optimal health.

Work Experience

Advisor Medical Expert / Clinical PA Pharmacist Lead

June 2023 – Present

Gainwell Technologies (RI & Texas Account)

Spearheaded the development of an enhanced automated prior authorization (PA) system for the Texas account, increasing efficiency and accuracy, which now serves as a template for all other accounts within the organization.

Lead a team of pharmacists in managing prior authorizations for a newly onboarded account, ensuring effective and accurate processing of requests.

Collaborated closely with cross-functional teams, including call center supervisors, operations managers, claims, and Quality Assurance, to optimize PA decision-making processes. Developed presentations and tests for coordination of benefits improvements.

Hemophilia treatment expert, delivering specialized presentations for pharmacy-related accounts and ensuring that treatment protocols and drug utilization were aligned with best practices.

Led a critical drug configuration initiative, identifying and rectifying medication errors that resulted in significant cost savings by avoiding accumulating fines and penalties.

Improved database accuracy, ensuring that medications were correctly classified under Medicare Part D, Part B, and "wrap-around services" to prevent improper Medicaid charges.

Developed and implemented a Quality Assurance (QA) process for annual clinical criteria reviews, along with regular updates for drug lists, ensuring continuous compliance and operational accuracy.

Maintained cutting-edge knowledge of medications and clinical prescribing practices, offering expert guidance to leadership on emerging trends and evidence-based decisions.

Authored consultations and intervention scripts, supporting continuous improvement efforts and facilitating quality enhancement within the clinical processes.

Contributed to clinical leadership in the review and decision-making process for Preferred Drug List (PDL) placement and clinical criteria recommendations.

Completed a master’s in public health (MPH), graduating magna cum laude, with applied expertise in population health analysis to guide interventions for the Drug Utilization Review Board.

Pharmacy Manager July 2021 – June 2023

Walgreens – Greenville, RI

Oversaw the administration of Covid-19 testing, vaccinations, while completing the necessary tasks of filling prescriptions safely and efficiently, preparing schedule, and coordinating staff assignments

Solution creator and advocate for quality customer care and service while understaffed

Effectively orchestrated collaboration with the store and district manager in creating improvement initiatives to workflow and other mitigation strategies offering greater financial margins, increased customer satisfaction, and promoting pharmacy safety

Actively participated in the recruitment, interviewing, and hiring of pharmacy staff along with orientation and training

Addressed pharmacy related incident reports, complete root cause analysis, make available staff training & re-education,

Actively developed a positive and healthy culture within the pharmacy as well as with the front store staff

Ability to successfully outreach to five assisted living, long-term care, and employers in the surrounding pharmacy community to provide Covid and flu vaccination services.

Immunization and Staff Pharmacist December 2020 – June 2021

CVS Health - Providence County, RI

Provided leadership in COVID-19 vaccination clinics in nursing homes, assisted living facilities, and retail store clinics throughout the state of RI immunizing approximately 150-200 residents per day.

Ascertained crucial business opportunities and advanced productive solutions to navigate growth and boost pharmacy performance concerning vaccine rollout operations through effective collaboration with other departments

Performed quality assurance functions including proper temperature regulation, transportation, operation of storage equipment and systems, maintenance of all documentation, and accurate handling of vaccines during disaster situations

Contributed to the healthcare of people on their journey to optimal health from counseling on prescriptions to supporting the management of complex chronic and specialty diseases including hemophilia and cancer with empathy and compassion patients

Motivated, influenced, and enhanced pharmacy support staff by assessing tasks that optimize colleagues’ assets, focusing on development opportunities and teaching new skills to provide improvements to overall pharmacy operations.

Clinical Program PBM Pharmacist February 2015 – July 2020

Magellan Rx Management PBM - Middletown, RI

Achieved optimal results among the pharmacy division in quality TMRs concerning high-risk medications that were presented in a published study at the Academy of Managed Care national conference in 2016

Performed quality telephonic comprehensive medication reviews (CMR), targeted medication reviews (TMR), and medication therapy management (MTM) surpassing pharmacy clinical quality measure averages across the country including Stars and HEDIS

Produced and delivered call center presentations on hemophilia disease management and the history of managed care increasing understanding of the disease to be utilized to enhance clinical programs for clients causing an increase in business and profitability

Lead member of the company's local charity chapter coordinating events and fundraisers to raise awareness of hemophilia and other bleeding disorders and collaborated with other nonprofit organizations to capitalize on enhanced efforts to increase the footprint of the company both locally and nationally increasing employee morale amplifying productivity

Developed clinical program improvements and practice efficiencies, shared best practices, and provided engaged coaching and instruction to team members enhancing efficiency of programs by 25%

Optimized health plan doses for IVIG therapy saving $500K within three months and provided 65% of the conversions to adjusted body weight dosing

Pharmacogenomic Clinical Research Associate June 2014 – December 2014

Renaissance RX - New Orleans, LA

Communicated for efficient and effective outcomes with Clinical Research Coordinators/Study Coordinators, other Clinical Staff, Regulatory Personnel, Investigators, and Director of Clinical Operations

Led efforts to ensure compliance with Standard Operating Procedures (SOP) and Good Clinical Practice (GCP) by maintaining systems to register and monitor patients

Clinical Infusion Pharmacist May 2013 – June 2014

Critical Care Systems - Providence, RI

Implemented improved USP 797 quality initiatives including in-use accuracy testing, preventative maintenance, repairs, and comprehensive record keeping and documentation to manage full-cycle infusion pumps which increased efficiency by 25%

Advanced organizational goals by maintaining training and expertise in antibiotic, hyperemesis, and chemotherapies, and clinically mastered IV medications, sterility, and stability data to provide optimum formulation for patient need

Consultant Pharmacist September 2012 – March 2013

Sequence - East Greenwich, RI

Utilized lab testing to determine genetic markers involved in drug metabolism to customize medical treatments and create a comprehensive personal medication therapy plan with the goal of optimal health

Recognized as one of the first pharmacists in RI to assist physician in providing DNA testing for the purpose of individualized Mediation Therapy Management

Clinical Staff Pharmacist January 2007 – March 2012

Eleanor Slater Hospital - Cranston, RI

Collaborated with healthcare professionals to monitor and assess drug or drug regimen effectiveness using weekly medication chart reviews for patients with severe psychological and physical disabilities.

Demonstrated meticulous attention to detail in the preparation and quality assurance of sterile medications and ensuring records were complete, accurate, and complied with regulations.

Additional experience includes Clinical Infusion and Staff Pharmacist with Pawtuxet Valley Pharmacy, Floater Pharmacist with CVS Pharmacy, and Pharmacy Manager with Walmart Pharmacy.

Education

Master of Science in Public Health March 2024

Southern New Hampshire University

Bachelor of Science in Pharmacy May 1998

University of Rhode Island

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