Managed Care Pharmacist Resume
Objective : As a Managed Care Pharmacist, responsible for preparing and submitting appeals to insurance companies for denied claims, providing comprehensive clinical justifications, supporting documentation, and relevant research. Track and document all appeals, ensuring timely follow-up and resolution.
Skills : Medication Therapy Management, Formulary Management.
Description :
- Verified prescriptions to be dispensed contained the correct medications and were correctly labeled, according to corporate and regulatory guidelines.
- Provided oversight and quality assurance to pharmacy technicians.
- Provided patient counseling on new prescriptions and handled patient clinical queries.
- Trained and mentored other less experienced or new pharmacists and/or technicians.
- Prepared compounding instructions and infusion pump programming requirements accurately as determined by established procedures for pre-check by the pharmacist.
- Adhered to quality control procedures as indicated in policies to meet ISO standards.
- Assisted the pharmacist in notifying the healthcare team if there were changes in therapy for individual patients.
Experience
0-2 Years
Level
Entry Level
Education
Pharm.D
Managed Care Pharmacist Resume
Summary : As a Managed Care Pharmacist, responsible for answering clinical questions from patients regarding their medications, potential side effects, drug interactions, and proper administration. Provide clear and accurate information to patients, helping them understand their treatment plans and address any concerns.
Skills : Prior AuthorizationPprocesses, Utilization Management Strategies.
Description :
- Maintained pharmacy records including filing and documenting required information on dispensing records and prescription hardcopy.
- Followed established procedures for obtaining equipment and supplies ensuring adequate inventory levels of equipment and supplies.
- Scheduled patients for refills as required and performed accurate refill processing through the prescription software according to established procedures.
- Monitored selected measures of individual performance as they related to departmental performance standards and reported results as requested.
- Participated in Performance Improvement activities and continuous professional development as required.
- Worked directly with the public in selected clinical programs under the supervision of a pharmacist.
- Attended and participated in departmental and business meetings as scheduled.
Experience
10+ Years
Level
Senior
Education
Bachelor's Degree in Pharmacology
Managed Care Pharmacist Resume
Summary : As a Managed Care Pharmacist, responsible for verifying patient eligibility and coverage by contacting insurance companies and obtaining necessary information. Collaborating with the patient support program team to ensure accurate and up-to-date insurance information is recorded.
Skills : Communication, Data analysis.
Description :
- Assisted in supporting and implementing care plans, vaccination services, and chronic disease management programs, including medication management services.
- Coordinated and participated in community and in-store health promotional events.
- Worked with employer groups to find clinically appropriate ways to manage costs.
- Contracted with manufacturers, pharmacies, employers, and health plan clients to ensure quality services were provided by mail and specialty pharmacies for patients.
- Evaluated and educated clients to make cost-effective drug and program choices.
- Evaluated data to make formulary decisions for populations of patients.
- Used evidence-based medicine to develop and implement clinical programs to enhance adherence and safety.
Experience
7-10 Years
Level
Management
Education
Pharm.D
Managed Care Pharmacist Resume
Objective : As a Managed Care Pharmacist, works closely with healthcare providers, including physicians and pharmacists, to gather necessary clinical information, collaborate on appeal strategies, and provide clinical recommendations.
Skills : HIPAA, CMS, Collaboration.
Description :
- Identified clinically appropriate programs that lowered the overall costs of healthcare.
- Developed and maintained expertise in the Medicare Part D program.
- Prepared and conducted training appropriate for meeting the needs of the customers and staff.
- Analyzed customer complaints and overall operational processes.
- Directed and facilitated the completion of special projects as assigned.
- Focused on strategies to reduce pharmacy expenses.
- Conducted clinical drug reviews and monitored the impact of the Preferred Drug List.
Experience
2-5 Years
Level
Executive
Education
Pharm.D
Managed Care Pharmacist Resume
Objective : As a Managed Care Pharmacist, prepares infusion supply orders for each individual patient to ensure accuracy related to patient-specific medical orders as determined by established procedures for pre-check by the pharmacist.
Skills : Research, Working with patients.
Description :
- Assisted in the development of statewide and national clinical programs.
- Reviewed health plan formularies and related data.
- Recognized the various stakeholders and pharmacist roles in managed care that contributed to medication use management in health systems.
- Discussed approaches for health plans and pharmacy benefit management companies to manage medications.
- Compounded and dispensed medications, as prescribed by physicians.
- Monitored customers’ drug therapies, advised interventions, and informed customers of any potential side effects.
- Instructed customers on how and when to take prescribed medications.
Experience
0-2 Years
Level
Junior
Education
Doctor of Pharmacy
Managed Care Pharmacist Resume
Summary : As a Managed Care Pharmacist, responsible for the integrated achievement of the Pharmacy Department and Company objectives. Works on issues of diverse scope requiring situation and data analysis with evolving problem solving and using tools to determine optimal solutions.
Skills : Managing budgets, Formulary development and management.
Description :
- Conducted health and wellness screenings.
- Provided immunizations, and other medical services, such as taking blood pressure, temperature measurements, and checking blood sugar levels.
- Kept accurate customer records.
- Ensured a safe and clean working environment.
- Completed operational requirements of the pharmacy, including verifying order entries, maintaining records of controlled substances, and charges, and removing expired and/or damaged drugs from the pharmacy’s inventory.
- Adhered to applicable legal rules, regulations, and procedures governing pharmaceutical practice.
- Reviewed the roles that the pharmacist occupied in managed care organizations.
Experience
7-10 Years
Level
Consultant
Education
Doctor of Pharmacy
Managed Care Pharmacist Resume
Objective : As a Managed Care Pharmacist, performs assigned duties necessary to provide for the efficient daily operation of the pharmacy, providing quality products to home and community care patients.
Skills : Pharmacy expertise, Organization.
Description :
- Discussed the key areas in which managed care pharmacists could impact patient outcomes.
- Reviewed prescriptions from doctors to ensure accuracy, ascertain the needed ingredients, and evaluate their suitability for the patient.
- Provided information and advice about drugs, their side effects, correct dosage, and proper storage.
- Kept records such as pharmacy files, patient profiles, charge system files, inventories, and registries of poisons, narcotics, or controlled drugs.
- Planned, implemented, or maintained procedures for mixing, packaging, or labeling pharmaceuticals, according to policy and legal requirements, to ensure quality, security, and proper disposal.
- Assessed the identity, strength, or purity of medications.
- Worked with other healthcare professionals to plan, monitor, review, or evaluate the quality or effectiveness of drugs.
Experience
0-2 Years
Level
Fresher
Education
Pharm.D
Managed Care Pharmacist Resume
Objective : As a Managed Care Pharmacist, responsible for significantly complex decision making. Cooperative problem-solving and negotiating at multiple levels inside and outside the Pharmacy Department. Provides day-to-day leadership of teams.
Skills : Medication therapy management, Patient counseling.
Description :
- Ordered and purchased pharmaceutical supplies, medical supplies, or drugs, maintaining stock and storing and handling it properly.
- Analyzed prescribing trends to monitor patient compliance and prevent excessive usage or harmful interactions.
- Advised customers on the selection of medication brands, medical equipment, or healthcare supplies.
- Utilized practice knowledge and skills to execute clinical initiatives for the health plan.
- Used data to measure quantifiable outcomes and interventions.
- Reported progress to the leadership team.
- Participated in the completion of medication appeals.
Experience
2-5 Years
Level
Executive
Education
Pharm.D
Managed Care Pharmacist Resume
Summary : As a Managed Care Pharmacist, responsible for preparing a medication summary and personal care plan with recommendations for the patient to share with their medical providers.
Skills : Teamwork, Integrity.
Description :
- Reviewed complex clinician-administered drug prior authorizations or fair hearing requests as needed.
- Completed clinical and compliance tasks.
- Participated in the education of parents/members, providers, employees, and pharmacy students.
- Participated in the education and training of health plan employees, pharmacy students, and non-pharmacy personnel.
- Developed an educational program and a plan and incorporated it into the pharmacist's routine increasing their clinical knowledge.
- Collaborated effectively with other members of the Texas Children's system to ensure the best outcomes for members.
- Maintained patient confidentiality as documented by lack of complaints and peer review.
Experience
7-10 Years
Level
Management
Education
Pharm.D
Managed Care Pharmacist Resume
Summary : As a Managed Care Pharmacist, responsible for assisting in the data entry and processing of medical orders, receiving phone calls, and assisting with tasks within scope to ensure smooth workflow in the pharmacy.
Skills : Computer competencies, Patient focus.
Description :
- Implemented medication therapy management programs to optimize therapeutic outcomes while minimizing costs for managed care members.
- Collaborated with healthcare providers and payers to develop and implement medication utilization strategies, including prior authorization criteria and step therapy protocols.
- Conducted comprehensive medication reviews to identify potential drug therapy problems and opportunities for intervention.
- Managed the formulary system, evaluating new medications for inclusion and assessing existing formulary agents for safety, efficacy, and cost-effectiveness.
- Provided drug information support to healthcare providers, including evidence-based recommendations and medication-related literature reviews.
- Participated in quality assurance activities, including medication utilization evaluations, adverse drug event monitoring, and medication safety initiatives.
- Contributed to the development and maintenance of clinical guidelines and protocols for medication use.
Experience
10+ Years
Level
Senior
Education
Pharm.D
