Clinical Pharmacist Health Consultant in Pittsburgh PA Resume Michele Mosier
Clinical Pharmacist Health Consultant in Pittsburgh PA Resume Michele Mosier
Clinical Pharmacist Health Consultant in Pittsburgh PA Resume Michele Mosier
Served as liaison between Operations and Government Compliance Department, including but not limited
to the following tasks: CMS audit remediation efforts, new or revised guidance interpretation and
implementation, CMS Call Letter initiatives, and CMS audit readiness.
Supported quality improvement and compliance efforts within the Clinical Operations Department by
performing monthly audits.
Provided the necessary support to train staff on various compliance related topics.
Assisted in the development of Highmarks Drug Formularies by writing drug monographs for Pharmacy &
Therapeutics Committee review.
Assisted in the development and implementation of utilization management programs, including but not
limited to: prior authorization, dose and duration edits, quantity limits, and medical policy review and
development.
Provided clinical review and decisions, including but not limited to: physician and member appeals.
Identified and assisted in managing department process improvements to maximize overall efficiencies.
Participated in Medicare Stars performance measures to drive contribution to excellence.
Mentored residents through various compliance initiatives.
Reviewed clinical appeals, maintaining compliance with ERISA, Medicare and client specific
requirements. Completed data analysis, and reviewed medication exception requests.
Assisted in the development of various audits for the Quality and Audit team.
Supported quality improvement efforts within the Clinical Operations Prior Authorization and Appeals
department to ensure compliance and improve quality.
Selected, pulled, and reviewed cases to ensure compliance with department policies and procedures and
clinical appropriateness criteria are met.
Collaborated with management to recommend process improvements based on audit findings.
Assisted in the development and implementation of Medhok, a new operating system.
Trained clinical pharmacists in Raleigh, NC and Salt Lake City, UT on various Medicare Part D topics and
Medhok.
Michele Mosier
Washington PA 15301 mosier7307@hotmail.com
www.linkedin.com/in/michelemosier
Managed the pharmacy team that included a pharmacist, technician, and a student intern. Analyzed and
reacted to sales performance, customer service scores and other metrics. Recruited and hired for all open
positions. Controlled expenses through payroll hours.
Answered all statewide legal questions relating to pharmacy laws in Pennsylvania as the Legal Resource
Captain at Target. Researched answers via multiple resources including the Pennsylvania Board of
Pharmacy.
Accepted challenge to become Donation and Volunteer Captain. Partnered with the community to gather
all charitable requests. Distributed all approved requests and managed within the predetermined budget.
Identified volunteer event opportunities through networking with the community; recruited team members
to participate in scheduled events; and ensured that each was recognized for their commitment.
EDUCATION
Duquesne University
Doctorate in Pharmacy 2001
Active Pharmacist License in the following states: Pennsylvania, Ohio, and Maryland.
VOLUNTEER
Deliver Medication Therapy Management Services for an independent consultant.
April 2015 - Present