- Optimized drug therapy and eliminated gaps in care through comprehensive/quarterly/targeted medication reviews, drug utilization reviews, and adherence discussions with patients in all states.- Reviewed therapy plans and recommended alternative medications, dosing changes, or other modifications by partnering with physicians, pharmacists, and medical staff, as appropriate. - Completed Medication Therapy Management, National Certificate Training, PowerPak CE, 28 CEU.

- Collaborated with leadership and PBM on Medicare formulary strategy and template selections & modifications to ensure successful annual CMS bid and formulary submissions.- Developed and implemented continuous improvement strategies to ensure the purpose and intent of the formulary strategy was adequately communicated and supported across the organization. - Collected feedback through surveys, focus groups and one-on-one discussions, worked cross-functionally to reduce and prevent CTMs, and developed and facilitated pharmacy formulary training content.

Manager, 9/2017 - 1/2019, Clinical Pharmacist, 6/2014 - 9/2017- Successfully managed Medicare formulary materials for plan years 2014-2018, with zero findings on numerous CMS and Acumen audits, including the following responsibilities:- Ensured all CMS Medicare marketing requirements were met, collaborating with member communications annually to develop formulary materials: Annual Notice of Change, Comprehensive Formularies, PA and ST Criteria, and Notice of Change documents. - Worked with PBM, to ensure all HPMS monthly submissions, negative change requests, and utilization management change requests were successfully completed, accurately and timely. - Updated Medicare formularies in formulary management system, Formulary Navigator (FN) to refresh Formulary Search Tools on the websites and create monthly formulary materials for both print fulfillment and website posting, in accordance with timelines of CMS marketing requirements.- Integrated organizations acquired into current processes through active participation in work stream meetings and by working with point people individually.- Served as the FN subject matter expert and managed relationship with vendor, MMIT to ensure proper function, reported issues are quickly resolved, requested system enhancements were implemented, and formulary services team members were properly trained. - Identified opportunities for strategic formulary/PDL updates, through drug utilization evaluations (DUE) and therapeutic class reviews, and performed at least one DUE and one P&T clinical update each year.- Performed ongoing review & update of Formulary Department step actions. Provided Formulary Department processes to business partners as needed for NCQA, CMS or internal audits.

- Project management and oversight of P&T meetings to include selection of topics & drug class review, timely completion of presenter and formulary department deliverables, review of submitted presenter data and recommendations for drug class reviews, new drugs/indications, and FDA Safety Alerts, review of rebate information, and other functions as required.- 2014 P&T Committee change planning and implementation – USP to Medi-Span classification, PBS/RxClaim utilization reporting, and Formulary Navigator use to reduce manual functions for both presenters and the formulary department.- Assisted with reviewing and updating Medicaid Preferred Drug Lists converted from Zynchros to Formulary Navigator (formulary management systems). - Review of PBM coding directive documents, following formulary coordinator input, to answer questions and correct errors to ensure appropriate direction to the PBM for programming and messaging. - Decision tool review, student and resident oversight, and other duties as assigned.

- Managed and evaluated a team of 15 technicians ensuring departmental goals of compliance, productivity, and quality were met. - Reviewed Medicare and Medicaid prior authorizations and coverage determination requests to ensure clinical appropriateness and optimization of care.- Prepared and presented Pharmacy and Therapeutic drug monographs and Drug Utilization Reviews.- Streamlined and managed the referral process for at-risk Medicaid members from Pharmacy to Corporate Behavioral Health Case Management.

- Responsible for 70 specialist pharmacists, 29 direct reports – 16 work at home/13 on site.- Trained and supported specialist pharmacist certificate programs for diabetes, cardiovascular, neuroscience, pulmonary and specialty.- Analyzed trends in performance metrics and provide coaching to low performers.- Monitored and scored direct reports’ calls for quality and compliance and record for audit.- Worked with client services team to resolve member/client escalations.- Acted as subject matter expert to research questions and concerns from staff and colleagues.

- Made outbound calls to counsel members regarding health conditions, medications and best use of prescription benefits.- Contacted providers to obtain and enter verbal orders for other outbound calling departments.- Supported management when necessary to achieve program goals and expectations.- Provided training and acted as subject matter expert for team members on issues relating to processing member requests.

- Maintained superior accuracy and customer service in retail pharmacies dispensing 350 to 1200+ prescriptions per week (2 years at 1200+, 6 months at 350).- Built and maintained relationships with customers based on trust and empathy.- Assisted with inventory control, outdates, narcotic audits, management of technicians, and other duties delegated by Pharmacy Manager.

- Worked as a team with the pharmacist and technicians to dispense prescriptions - Provided medication consultations and general customer service- Floated to other stores in the district to assist with technician shortages- Participated in intern program, learning basic workings of other departments

- Prepared general and directed marketing mailings and proposals under a deadline- Tracked job requirements and updated reports - Researched potential client opportunities via internet and newspaper ads

Account Representative (12 m)- Assisted business clients with exchange of broken pagers, billing problems, etc. - Increased business by soliciting additional sales from existing business clients and selling new individual accounts through employee programs and referrals.Technical Coordinator (19 m)- Managed incoming trouble reports and questions by phone.- Generated monthly/quarterly reports pertaining to expenses, outages, and leases.Customer Care Representative (8 m)- Took incoming calls regarding invoices and pager programming and coverage.