Prior Authorization Pharmacist Resume
Objective : As a Prior Authorization Pharmacist, collaborated with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements.
Skills : Understanding of pharmacology, Therapeutics.
Description :
- Evaluated and reviewed all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
- Verified insurance coverage and eligibility, interpreted clinical guideline criteria, consulted physicians and other healthcare providers, and appropriately utilized clinical knowledge and resources while complying with department protocols.
- Performed and handled inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
- Established and maintained communication among CVS Caremark, health plan, and employer group staff.
- Maintained professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
- Performed other related projects and duties as assigned, including attending training sessions and development meetings.
- Provided on-call and after-hours pharmacist availability as needed.
Experience
2-5 Years
Level
Executive
Education
Doctor of Pharmacy (Pharm.D.) degree
Prior Authorization Pharmacist Resume
Headline : As a Prior Authorization Pharmacist, responsible for providing consultations and answering inquiries from patients, healthcare professionals, and physicians regarding drugs, potential side effects, and specified use, responsible for educating patients on proper medication use.
Skills : Disease management. Familiarity with common medications and their uses.
Description :
- Responsible for monitoring the ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Responsible for counseling customers on medications, appropriate dosage, and potential side effects.
- Responsible for performing technical processes required to dispense medications to patients.
- Responsible for supervising and coaching a team of pharmacy technicians and trainees.
- Responsible for completing accurate cycle counts, inventory management, and will-calls for customers.
- Responsible for counting controlled medications, measuring liquids, and reconstituting antibiotics.
- Responsible for counseling patients regarding proper intake of medications.
Experience
5-7 Years
Level
Executive
Education
Doctor of Pharmacy (Pharm.D.) degree
Prior Authorization Pharmacist Resume
Summary : As a Prior Authorization Pharmacist, responsible for conducting research in the field of clinical pharmacy, contributing to advancements in patient care practices, responsible for evaluating medication regimens for complex patients, identifying potential drug interactions, and devising alternative treatment strategies when necessary.
Skills : Knowledge of healthcare laws, regulations, and guidelines.
Description :
- Responsible for collaborating with interdisciplinary healthcare teams for optimal patient care and improved treatment outcomes.
- Responsible for assisting other pharmacy staff with drug inventory, purchasing, and receiving.
- Responsible for advising patients on medication side effects and contraindications and explaining proper administration.
- Responsible for displaying patient-oriented and comprehensive clinical pharmacy services and pharmaceutical care.
- Responsible for dispensing and verifying patient prescription orders, and conducting necessary utilization reviews.
- Responsible for achieving and maintaining top customer satisfaction and retention by cultivating productive relationships with patients.
- Responsible for managing drug and supply inventories.
Experience
7-10 Years
Level
Management
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Objective : As a Prior Authorization Pharmacist, responsible for improving patient outcomes by providing medication therapy management and comprehensive pharmaceutical care to diverse patient populations, responsible for leading patient-focused initiatives to enhance the overall patient experience within the healthcare system, resulting in higher levels of satisfaction and trust among patients.
Skills : Understanding of insurance and reimbursement processes, Ability to evaluate clinical information and make informed decisions.
Description :
- Responsible for developing strong relationships with healthcare providers, facilitating communication and collaboration for better patient care coordination.
- Responsible for overseeing inventory management processes within the pharmacy department, ensuring accurate tracking of medications for regulatory compliance purposes.
- Responsible for enhancing clinical pharmacy services through the development and implementation of evidence-based protocols and guidelines.
- Responsible for assisting with the development of institution-specific order sets to standardize prescribing practices throughout the hospital system.
- Responsible for mentoring pharmacy students and residents, fostering a supportive learning environment that promoted professional growth.
- Responsible for serving as a drug information resource for healthcare professionals, improving prescribing practices across the institution.
- Responsible for advising physicians on how to properly dose medications.
Experience
2-5 Years
Level
Executive
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Headline : As a Prior Authorization Pharmacist, responsible for participating in continuous professional development activities to stay current on evolving trends within clinical pharmacy practice, responsible for participating in quality improvement initiatives to optimize clinical pharmacy services within the organization.
Skills : Proficiency in interpreting medical records and insurance policies, Communication Skills.
Description :
- Responsible for supervising the dispensation of Schedule II and III drugs.
- Responsible for contributing to antimicrobial stewardship efforts by monitoring antibiotic usage patterns and making recommendations for targeted improvements.
- Responsible for providing input on strategic planning initiatives aimed at advancing organizational goals related to clinical pharmacy services.
- Responsible for implementing cost-saving measures through formulary management and utilization review, ensuring efficient use of resources while maintaining high-quality patient care standards.
- Responsible for streamlining the medication reconciliation process, reducing medication errors, and enhancing patient safety.
- Responsible for managing and mentoring staff of a Number of new employees and delivered focused Type training.
- Responsible for presenting clinical findings at national conferences, and promoting knowledge sharing among peers in the industry.
Experience
5-7 Years
Level
Executive
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Summary : As a Prior Authorization Pharmacist, responsible for educating patients on possible drug interactions, potential side effects, and optimal methods of administration.
Skills : Detail-Oriented, Strong attention to detail.
Description :
- Responsible for playing an integral role in emergency response situations, providing expert guidance on appropriate drug therapy interventions during critical moments of patient care.
- Responsible for educating patients on proper medication use and adherence, leading to improved health outcomes and decreased hospital readmissions.
- Responsible for partnering with physicians and other members of the healthcare team to optimize patient care through effective use of medications.
- Responsible for interpreting prescriptions from healthcare providers to properly dispense medications and health products.
- Responsible for analyzing trends in medication use and making recommendations for policy updates.
- Responsible for evaluating patient histories to assess medication compliance and spot issues such as doctor shopping or excessive usage.
- Responsible for helping patients overcome vaccine hesitancy by providing facts about efficacy and safety data.
Experience
7-10 Years
Level
Management
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Summary : As a Prior Authorization Pharmacist, collaborated on planning and executing the sales strategy, involvement in presentations, and participation in client meetings as appropriate. Responsible for handling Medicare Part D prior authorization reviews.
Skills : Proficiency in managing appeals and denials, Familiarity with electronic health records (EHR).
Description :
- Responsible for authorizing medication review cases / speaking with Physicians and Nurses constantly to approve and/or deny medications for a member.
- Responsible for making clinically sound and confident decisions on cases based on clinical guidelines and professional judgment.
- Responsible for reviewing and accurately interpreting physicians' orders by checking the appropriateness of orders as to indication for clarity, the accuracy of dose, drug allergy, potential drug interactions, and duplications, and making a clinical judgment based on patient's medication history.
- Responsible for providing clinical knowledge to Physicians over the phone about questions and interpretations of clinical guideline criteria and coverage determinations rendered.
- Responsible for demonstrating pharmacy knowledge, drug utilization review, and excellent consultation skills relating to customer service.
- Responsible for managing pharmacy technicians and training them on clinical information on patients.
- Responsible for training pharmacy residents and interns on clinical care and medication dispensing.
Experience
7-10 Years
Level
Management
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Headline : As a Prior Authorization Pharmacist, made decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.
Skills : Decision-Making, Problem-Solving Skills.
Description :
- Experienced in successfully leading cross-functional teams to achieve improvements.
- Expanded new business, grew client relationships, and obtained client referrals.
- Experienced with a focus on customer service, goal setting, and coaching.
- Exhibited proven leadership, delegation, and project management skills.
- Influenced without authority.
- Shared own professional insights, expertise, and knowledge to develop critical thinking across the business.
- Directed and matrix reporting structures.
Experience
5-7 Years
Level
Executive
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Headline : As a Prior Authorization Pharmacist, assisted in managing and training Pharmacy techs for Medication therapy management, understood the mandates, and followed the guidelines.
Skills : Clinical Skills, Coordinating Skills.
Description :
- Supported clinical programs both internally and externally.
- Assisted with the internal drug information services.
- Called responsibility as required.
- Reviewed and analyzed reports on utilization management, and evaluated business needs for data analysis.
- Supported the Drug Utilization review program.
- Managed and updated formulary communications.
- Coordinated projects with activities performed by other clinical Pharmacists for the residents and students.
Experience
5-7 Years
Level
Executive
Education
Doctor of Pharmacy
Prior Authorization Pharmacist Resume
Headline : As a Prior Authorization Pharmacist, used clinical resources, Micromedex, Lexicomp, and Clinical Pharmacology, prioritized, quickly assessed, managed multiple tasks, and adapted to constantly changing situations.
Skills : Pharmacist, Good communicational skills.
Description :
- Worked independently and made clinical decisions.
- Experienced using MS Office and other Windows-based computer applications.
- Received phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
- Active pharmacist license that is in good standing in the state of residence.
- Exposured to clinical and analytical problem-solving.
- Consulted with pharmacy technicians and/or physicians regarding the use of medications and advised of appropriate formulary alternatives when requested.
- Experienced with clinical decision-making while applying evidence-based clinical guidelines/criteria; and utilizing formularies/preferred drug lists.
Experience
5-7 Years
Level
Executive
Education
Doctor of Pharmacy
