Customer Service Health Care

DON LE

Las Vegas, NV ***** Primary contact: ******@*****.*** Mobile phone: 702-***-****, Time Zone: PST

CAREER SUMMARY

Accomplished, conscientious, committed and highly motivated Pharmacist with the best and the highest standards of customer service to patients, and with a track record of ensuring the success of high volume, fast-paced pharmacy operation; presently contributed to the fulfillment of 250,000 prescriptions each week on behalf of a diverse roster of enterprise accounts that include Department of Defense-Tricare, Lockheed Martin, Anthem Blue Cross-Blue Shield, United Health Care and FedEx

Effectively managed day-to-day operation of some busiest retail pharmacies such as

Sav-On/Albertsons, Walgreens, Costco, etc.; presently contributed to the fulfillment of 2,500 prescriptions per week

Ability to motivate sales force and maintain a satisfied customer base, and build great relationships and opportunity to significantly contribute to the bottom line; presently contributed to the fulfillment of 1.8 million dollars sales per month on HIV/AIDS, high-cost and rare medications

Provided superior service to ensure customer satisfaction, and determine how to triage or respond to questions and genuinely interested in the best interest of the patient, history of going above and beyond to provide support for those in dire physical need or advanced stages of disease by acting as a key resource and healthcare partner

Eager to integrate extensive experience, customer-centric focus and pharmacy operations expertise toward supporting the goals of a busy pharmacy in a Pharmacist-In-Charge (P.I.C) role

Adept at service as an integral member of pharmacy staff, ensuring that the highest operational standards and customer service levels are met at all times

Outstanding leadership ability to organize, prioritize workload, interact with medical professionals to interpret medication orders, monitor drug regimens, and clarify patient instructions

Strong teamwork and ability to work in a fast-paced production environment and handle multiple tasks, but focus on expertise and attention to detail

Demonstrated excellent professional judgments, quick problem solving, decision making, impeccable time management, interpersonal, listening, verbal and written communication skills, and ability to interact with diverse populations

Expert on Clinical Pharmacy with highly knowledgeable in processing Medicare Part D and Prior Authorization (PA) claims

Adept at Prior Authorization - Reviewed and applied clinical criteria for approval/denial determinations or any appeal levels for Medicaid, Medicare Part D plans, Non-Formulary medications, Quality Limits, Step Therapy, Plan Exclusions and CMS Deletions, Commercial (Retail/Private), and a variety of health care plans such as United Health Care, Aetna, BCBS, etc.

Reviewed and made the decision on coverage determinations and provided timely drug therapy regimen for Medicare Part D plan members, and ensured adherence with Centers of Medicare and Medicaid Services (CMS)

Researched plan guidelines and approved compendium to make clinically sound decisions for each case

Provided critical attention to detail and accuracy in the complete process of medication orders

Answered clinical questions via telephone with patients and medical professionals. Ensured strict compliance and adherence to all regulatory state and federal contractual requirements

Discreet and dedicated professional charged with reviewing Medicare and Medicaid claims, ensuring clinical appropriateness and optimum care, and performing utilization management activities

Continually searched for ways to increase profits and productivity, controlled and reduced costs, and improved patient experiences.

SKILLS

Retail, Mail Order, Independent, Long-Term Care (LTC), Assisted Living Facility (ALF), Nursing Home, Senior RX program

Prior-Authorization (PA)

Pharmacy Benefit Manager (PBM)

Call Center

Managed Care

Medicare Part D and Medicaid claims (all tier levels)

Coverage determination

Utilization Management (UM)

Drug List Analysis (MONY, Rx/OTC coding)

Rx Claims

Clinical/data reviews and applications

Drug Utilization Review (DUR)

Medication Regimen Reviews (MRR)

Medication Therapeutic Management Program (MTMP)

Medication Therapy

In-patient/out-patient Hospitals

Pharmacy management and operation

Specialty pharmacy (Sterile/Non-sterile Compounding, HIV/AIDS, high-cost and rare medications)

Drug product and clinical pharmacy expertise, consumer awareness; leadership and excellent organizational, interpersonal, listening, verbal and written communication skills

Proficiency in: Microsoft Office software applications (Excel, PowerPoint, Access, Publisher, Word, Visio, etc.), QuickBooks, Pyxis Med Station system, Allscripts Gateway, Up-To-Date, Intercom Plus, PDX Pharmacy system, Condor, Script Assist and Compound Assist (RX Software), PCCA (Professional Compounding Centers of America), Home-based business computer builder/repairer.

PROFESSIONAL STANDING

Registered Pharmacist: Current, active, clear and unrestricted license in good standing, state of Nevada

Pharmacy manager, Pharmacist-In-Charge (P.I.C.)

Clinical Pharmacist (PBM, PA, Rx Claims, DUR, UM, DL, etc.)

Specialty Pharmacist (Sterile/Non-sterile Compounding, HIV/AIDS, high-cost and rare medications)

PROFESSIONAL EXPERIENCE

PHARMACY MANAGER, PHARMACIST-IN-CHARGE (P.I.C.)

Effectively day-to-day managed, supervised and oversaw all activities of Pharmacists, Technicians, Pharmacy Interns/students and supportive staff, and performed all clinical and administrative tasks including recruiting, hiring, training, scheduling, evaluating the performance of all pharmacy staff, as well as prioritized daily workload/tasks for pharmacy staff

Responded quickly to customer concerns using problem-solving skills, tact and discretion

Monitored department performance and pharmacy operations to ensure complete legal compliance and all work processes are performed efficiently and effectively

Managed and maintained proper inventory levels to company goals and oversaw perpetual inventory of controlled substances and all medications

Ensured and enforced regulatory compliance with state and federal laws and regulations, company policies pertaining to the dispensing of controlled substances and all other medications, and the maintenance of required records, and regarding licensure for pharmacy, Pharmacists, Interns, Technicians, and daily reported multi-State Prescription Drug Monitoring Program (PDMP), which collects designated data on substances dispensed

Provided clinical guidance, drug information, support and oversight to the assigned Technicians, pharmacy Interns/students

Reviewed department financials, payrolls, budgets, and sales in order to meet sales objectives and increased prescription volume and made a substantial contribution to pharmacy’s profitability

Management - An assertive and polished professional with comprehensive skills in the management of day-to-day operations in a professional work environment

Administrative - Successfully experienced in handling and supporting customers/consumers and professional relations including consulting, marketing, billing, and account management

Communications - Excellent interpersonal, listening, verbal and written communication skills, and experienced in the design and preparation of educational material for training personnel on how to use pharmacy’s software and computers

Planning and Analysis - Adept in policy, procedure, and work flow analysis, and experienced in the collection and analysis of data applied to marketing and budget planning.

SPECIALTY COMPOUNDING PHARMACIST

Prepared and complied with applicable state, federal and FDA compounding laws, regulations and guidelines for all essential pharmaceutical compounding USP standards such as 797, 795, 1206, 800, and applied the Good Compounding Practices (GCP) for the preparations of sterile and non-sterile compounded formulations

Compounded, dispensed and/or administered to patients a wide variety of compounded Specialty Pharmaceuticals and formulations include, but not limited to: Hormone Replacement Therapy (HRT), Growth Hormone, Fertility, Dermatology, Ophthalmology, Hemophilia, HIV/AIDS, Arthritis, Osteoporosis, Pain, Hepatitis, Oncology, IV, IM, SQ, Injectables, LVP, SVP, Piggyback, Syringes, Chemotherapies, Intrathecal, Epidural, Home and Institutional I.V. Therapy/Admixture, Total Parenteral Nutrition (TPN), Infusion Pumps, Unit Dose, Lozenges, Troches, Creams, Gels, Ointments, Lotions, Capsules and Suppositories

Specialized in HIV/AIDS, Oncology/Cancers, high-cost and rare medications

CLINICAL PHARMACIST

Fulfilled a critical role contributing to the success of pharmacy operations at the world largest Prescription Benefit Management (PBM) company and largest-scale Mail Order prescription company (Medco/Express Scripts), providing unsurpassed levels of prompt and professional service to key enterprise accounts that include Department of Defense-Tricare, Lockheed Martin, Anthem Blue Cross-Blue Shield, United Health Care and FedEx

Adept at Prior Authorization (PA) - Reviewed and applied clinical criteria for approval/denial determinations or any Appeal levels for Medicaid, Medicare Part D plans, Non-Formulary medications, Commercial (Retail/Private), and a variety of health care plans such as United Health Care, Aetna, BCBS, etc.

Pharmacy Benefit Manager (PBM) - Reduced prescription drug costs and improved convenience and safety for consumers, employers, unions, and government programs such as commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, managed Medicaid plans, and others. Primarily responsible for processing and paying prescription drug claims (Rx Claims), and responsible for developing and maintaining the formulary, drug analysis, utilization management, as well as contracting with pharmacies, and negotiating discounts and rebates with drug manufacturers

Call Center - Worked with patients to resolve issues about medication that has been prescribed; answered such concerns as dosage amount, frequency of administration, drug interactions, adverse drug effects or events, or any specialized requirements that may apply, as well as evaluating their plans of care to avoid any medication conflicts; provided medication therapy management, reaching out to patients who are not following the recommended therapy to do a comprehensive medication review; worked with doctors, nurses, health care professionals and hospitals, providing information and feedback, as well as collaborating on patient care and treatment regimens; provided clinical oversight of prior authorization requests, using established treatment protocols and clinical criteria to coordinate the review of such requests; also worked with other staff at the call center, making recommendations to the director of pharmacy about the center’s operating procedures to maintain good customer relations, as well as worked with healthcare teams at the call center to coordinate patient care

Reviewed, made coverage determinations and provided timely drug therapy regimen for Medicare Part D plan members, and ensured adherence with Centers of Medicare and Medicaid Services (CMS)

Oversaw Drug Utilization Review (DUR), Medication Regimen Reviews (MRR), Clinical Coverage Review and medication therapy management programs, and ensured to meet Medicare Part D regulatory requirements

Verified and ensured the accuracy of prescriptions and appropriateness of patients’ drug therapy through drug therapy regimen review and Drug Utilization Review or evaluation

Extensive background in, but not limited to, Prior Authorization(PA), Drug Utilization Review(DUR), Medicare Part D and Medicaid claims, Pharmacy Benefit Manager (PBM), Coverage determination, Utilization Management(UM), Drug List Analysis (MONY, Rx/OTC coding), Rx Claims, Clinical/data reviews, Drug Utilization Review (DUR), Medication Regimen Reviews (MRR), Medication Therapeutic Management Program (MTMP), Clinical review and applications, Medication Therapy, drug therapy regimen review, drug utilization evaluation, product substitution and therapeutic interchange, Clinical Coverage Review, Step Therapy plans, Formulary and Specialty drug programs, the Good Compounding Practices (GCP’s) for the preparations of sterile and non-sterile compounded formulations, drug information/knowledge, research and disease states

Extensive expertise in Pharmacist’s interpretation of prescriptions, drug order entry review, and efficiently dispensed prescriptions accurately, and optimized the safety and efficacy of the patients’ medication regimen by using a professional “The Five-Rights of Medication Administration Mission”: The Right patient, the Right drug, the Right dose, the Right route, and the Right time

Specialized in HIV/AIDS, high-cost and rare medications, Mail Order, and Geriatrics for Long Term Care (LTC)/Nursing Homes, Assisted Living Facilities (ALF), Home Health Care, Hospice Care, Memory Care/Alzheimer’s Care and Continuing Care Retirement Communities

Consulted, communicated and interacted with patients or members and other healthcare professionals, physicians and nurses regarding drug therapy and regimen, use of prescription and non-prescription medications, dosage, side effects, potential drug-drug, drug-disease, drug-food interactions and allergies, restrictions on diet, and all information necessary to encourage proper use and storage of the medications

Provided individualized patient/provider consultation; inbound/outbound calls, clinical consultation and knowledge to patients, doctors, and insurance plans as well as advice on the selection of Over-The-Counter (OTC) medications to treat common illnesses such as flu, cold sores, or headaches, etc., and educated patients on proper handling of medical devices, equipment, and supplies such as blood pressure monitors, glucose meters, as well as walking aids, wheelchairs, incontinence, etc.

Monitored patients’ medication compliance and therapy, as well as recorded and maintained pharmacy files, patients’ confidential profiles such as HIPAA, charts, information, documentation, and assigned records as required.

EMPLOYMENT

The Medicine Shoppe Pharmacy (Retail/ Long-Term Care/ Home Health Care/ Nursing Homes/ Hospitals/ Hospice Care/ Assisted Living Facilities (ALF)/ Contracts

Las Vegas, NV (Staff Pharmacist): January 2021 - current (PRN/On-Call)

* Performed and completed each day of the extremely high-volume prescriptions

* Worked in a fast-paced production environment and handled multiple tasks at the same time

* Effectively managed and operated my pharmacy everyday while still motivated sales force and maintained a satisfied customer base and built great relationships.

* Provided advice about health issues, symptoms and medication in response to customer enquiries

* Consulted with physicians, nurses and healthcare professionals about medications

* Responded to customers’ questions about medications and advised about drug safety and potential interactions

* Advised patients on the selection of Over-The-Counter (OTC) medications to treat common illnesses such as flu, cold sores, pains or headaches, etc.

* Educated patients on proper handling of medical devices, equipment, and supplies such as blood pressure monitors, glucose meters, as well as walking aids, wheelchairs, incontinence, etc.

Specialty RX Pharmacy (Independent/ Retail/ Contracts), Las Vegas, NV [(Pharmacy Manager, Pharmacist-In-Charge (P.I.C)]: January 2020 - December 2020

* Directly supervised all pharmacy staff, and answered all clinical questions from healthcare professionals and provided product information

* Ensured adherence to facility SOP’s and procedures, and to State and Federal regulatory laws, requirements and guidelines

* Assisted in daily operational pharmacy duties, and oversaw all aspects of the pharmacy operations

* Reviewed and checked prescriptions, prepared and dispensed all medications, and contributed to the fulfillment of all pharmacy’s sales, and provided superior service to ensure customer satisfaction

* Worked in a fast-paced production environment and handled multiple tasks at the same time

* Demonstrated skills to solve complex problems in a wide variety of high-pressure situations, and a strong ability to be adaptable and flexible

CVS Health/Caremark - Pharmacy Benefit Manager (PBM, Clinical), trained in Irving, TX at CVS Caremark Corporate Office, Irving, TX

(Clinical Benefits Consultant Pharmacist): February 2018 - December 2019 (Remote in Las Vegas, NV)

* Applied my clinical knowledge and professionalism upon approval and denial management processes

* Reviewed cases to determine if the medication is to be covered under Medicare Part B or Part D, and analyzed the pharmacy claims, drug coverage and drug utilization patterns

* Adept at Prior Authorization (PA), Medicare Part D, Tiers exceptions or Non-Formulary, and reviewed and applied clinical criteria for approval/denial determinations or any Appeal levels.

* Answered all clinical questions, interacted and communicated with prescribers, nurses and healthcare professionals for clinical information to make decision for each case

* Reviewed information and completed timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience

* Ensured accuracy of case setup and clinical review of Medicare appeals cases

* Provided clear, concise and accurate documentation for case reviews

* Complied with Centers for Medicare and Medicaid Services (CMS) mandated timelines, department productivity and quality standards

* Acquired and utilized clinical judgement and knowledge, drug compendia resources, relevant and changing work instructions, and CMS Medicare guidance

* Have strong interpersonal and organizational skills

Specialty All-In-One Pharmacy (Specialized in HIV/AIDS, high-cost and rare medications), Las Vegas, NV [(Pharmacy Manager, Pharmacist-In-Charge (P.I.C.)]: January 2017 - December 2019

* Contributed to the fulfillment of million dollars sales per month on HIV/AIDS, high-cost medications, and provided superior service to ensure customer satisfaction

* Worked in a fast-paced production environment and handled multiple tasks at the same time

* Reviewed and dispensed prescribed medications according to State and Federal regulatory laws, requirements and guidelines

Carson Tahoe Regional Medical Center Hospital Pharmacy (In-Patient/ Out-Patient), Carson City, NV (Clinical Pharmacist): March 2016 - February 2017

* Responsible and accountable for medication therapy and patient outcomes and a primary source of valid information on the safe, appropriate and cost-effective use of medications

* Committed to patient care by ensuring the safe and effective use of medications

* Advised healthcare professionals and patients about medications, and recommended dosages, drug therapy and administration routes

* Created and monitored drug charts to make sure medical staff members receive proper medication instructions, and communicated effectively with physicians, nurses, healthcare professionals and dietitians

* Compounded and formulated the right IV, IM, SQ, Injectables, LVP, SVP, Piggyback, Syringes, Chemotherapies, Intrathecal, Epidural, Home and Institutional I.V. Therapy/Admixture, Total Parenteral Nutrition (TPN), Infusion Pumps, Unit Dose, Lozenges, Troches, Creams, Gels, Ointments, Lotions, Capsules and Suppositories and dispensed medication dosage to ensure patients get the right dose of medications and chemotherapy

* Reviewed patients’ medications before they leave the hospital

Specialty Compounding Pharmacy, Las Vegas, NV [(Pharmacy Manager, Pharmacist-In-Charge (P.I.C.)]:

January 2014 - December 2016

* Reviewed prescriptions, prepared and compounded ((Sterile/Non-sterile Compounding), dispensed and/or administered to patients a wide variety of compounded Specialty Pharmaceuticals and formulations include, but not limited to: Hormone Replacement Therapy (HRT), Growth Hormone, Fertility, Dermatology, Ophthalmology, Hemophilia, HIV/AIDS, Arthritis, Osteoporosis, Pain, Hepatitis, Oncology, IV, IM, SQ, Injectables, LVP, SVP, Piggyback, Syringes, Chemotherapies, Intrathecal, Epidural, Home and Institutional I.V. Therapy/Admixture, Total Parenteral Nutrition (TPN), Infusion Pumps, Unit Dose, Lozenges, Troches, Creams, Gels, Ointments, Lotions, Capsules and Suppositories

* Complied with applicable state, federal and FDA compounding laws, regulations and guidelines for all essential pharmaceutical compounding USP standards such as 797, 795, 1206, 800, and applied the Good Compounding Practices (GCP) for the preparations of sterile and non-sterile compounded formulations

Monte Vista Hospital, Las Vegas, NV (Clinical Pharmacist): April 2012 - March 2014

* Monitored patients’ medication compliance and therapy, and dispensed medications accurately and correctly

* Reviewed the patients’ charts to look for allergies or medications that might have an adverse effect when combined, and met with patients to discuss their concerns regarding a new medication

* Committed to patient care by ensuring the usage and effective use of medications

* Interacted with physicians and nurses throughout the day about medication therapy

Express Scripts/Medco Pharmacy (PBM, Managed Care, Call Center, Mail Order), Las Vegas, NV

(Staff Pharmacist): January 2000 - November 2012

* Had Extensive background in Prior Authorization(PA), Medicare Part D plans and claims, Drug Utilization Review(DUR), Pharmacy Benefit Manager (PBM), Coverage determination, Utilization Management(UM), Drug List Analysis (MONY, Rx/OTC coding), Rx Claims, Clinical/data reviews, Medication Regimen Reviews (MRR), Medication Therapeutic Management Program (MTMP), Clinical review and applications, Medication Therapy, drug therapy regimen review, drug utilization evaluation, product substitution and therapeutic interchange, Clinical Coverage Review, Step Therapy plans, Formulary and Specialty drug programs

* Reduced prescription drug costs and improved convenience and safety for patients and consumers

* Worked in call center with patients to resolve issues about medications; answered such concerns as dosage amount, frequency of administration, drug interactions, adverse drug effects to avoid any medication conflicts, and provided medication therapy management, reaching out to patients who are not following the recommended therapy to do a comprehensive medication review

Costco Wholesale Pharmacy-(Retail), Las Vegas, NV (Staff Pharmacist): January 2001 - June 2003

Walgreens Pharmacy-(Retail), Las Vegas, NV (Staff Pharmacist): February 2000 - December 2001

Caro Pharmacy-Long Term Care (LTC), Nursing Homes, Assisted Living Facilities (ALF),

Home Health Care, Hospice Care, Memory Care/Alzheimer’s Care, and Continuing Care

Retirement Communities, Las Vegas, NV [(Pharmacy Manager, Pharmacist-In-Charge (P.I.C.)]:

January 2000 – December 2002

Sav-On/Albertsons Pharmacy-(Retail), Las Vegas, NV (Staff Pharmacist): January 1996 - December 2000

Federal Clinic Pharmacy- (Indian Paiute Tribe), Las Vegas, NV [(Pharmacy Manager,

Pharmacist-In-Charge (P.I.C.)]: January 1996 - December 1997

Prior to 1996, held staff Pharmacist position with Thrifty/Rite Aid Pharmacy, Kaiser Permanente Hospitals, Majeste’s Pharmacy, Conway Hospital, River Parishes Hospital, and Capaci’s Patio Drugs.

EDUCATION

Pharm. D. Program/ Bachelor of Science in Pharmacy: School of Pharmacy, the University of Louisiana at Monroe, LA

Major: Pharmacy, Music; Minor: Computer Science, Marketing, Accounting and Business Management

Graduate Student: Graduate Assistant for the University's Pharmacy Department and computer labs

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