Leslie Moore-Simons Email & Phone Number

Tallahassee, Florida Area

Oversees day-to-day operations of a team of call-center pharmacists to ensure department objectives and contractual service levels are met. Ensures adherence to standard operating procedures. Triages client and internal requests to resource assignment. Essential responsibilities: Monitors prior authorization process and adherence to client’s established clinical criteria. Serves as clinical lead for appeals and fair hearing processes, follows contractual obligations, helps to maintain NCQA accreditation and URAC accreditation, and follows State and Federal regulations. Manages staff resources, resource allocation, and staff schedules to ensure adequate work coverage. Regularly communicates necessary information including personnel relations activity including employment, termination, performance reviews, salary reviews and disciplinary actions. Implements quality assurance reviews consistent with corporate QA programs. Ensures annual and corporate training requirements are complete. Implements QA process and inter-rater reliability testing to staff. Mediates client escalated concerns, issues, and complaints. Assists account team executives with client issues. Provides end-user input to strengthen systems and unify internal clinical criteria. Analyzes daily, weekly, and monthly statistical reports and makes appropriate recommendations and forecasts regarding call volume and staff scheduling. Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, peer-to-peer reviews, calls to practitioners about product awareness, and prior authorizations. Performs other duties as required

Tallahassee, Florida Area

Performs prospective and/or retrospective drug utilization review and appeals per State and Federal regulations. Participates in the distribution of clinical drug information and educates providers and staff regarding the use of pharmaceutical treatment regimens. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions. Essential responsibilities: Provides prior-authorization services for formulary drugs, drug utilization review, and reviews assessment and documentation of patient care. Made recommendations to physicians and other prescribers on medication regimens as per plan guidelines. Assisted providers to ensure accurate dispensing and billing of products. Collaborated with other clinical personnel in assessing treatment guidelines. Maintained clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education and any company provided in-services. Completes all mandatory company provided on-line courses. Attended and completed all employee development courses. Make outbound or took inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations. Performed other duties as required.

Miami/Fort Lauderdale Area

Responsibilities included: Prescription translation verification, reviewing patient profiles for drug interactions, drug allergies and proper dosage, and making therapeutic interventions by contacting doctors or patients when necessary.

Miami/Fort Lauderdale Area

Prescription verification, dispensing, compounding, patient counseling, making O.T.C. product recommendations and addressing immediate customer concerns, receiving new prescription and refill orders called in by physicians and nurses, making necessary interventions regarding patient drug therapy (i.e. drug interactions, appropriate dosage, etc.), securing controlled substances and maintaining accurate dispensing records, and taking prescription transfers and copies from other pharmacies.