Gabriela Nevarez
La Puente
Summary
Accomplished Certified Pharmacy Technician with 9 years of comprehensive experience in pharmacy operations and PBM setting, seeking a dynamic role within a reputable healthcare facility to leverage clinical expertise, optimize medication management, and contribute to exceptional patient care.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Sr. Pharmacy Resolution Specialist
Centene Management
04.2024 - Current
- Triage incoming calls from Prescribers, Pharmacies, and Members.
- Assists with prior authorization-related inquiries.
- Efficiently obtain clinical information and ensures each inquiry meets clinical guidelines.
- Review and analyze pharmacy-related claims and overrides such as Refill Too Soon, Pharmacy Locks, Long-Term Care, Vacation, etc.
- Conduct research on plan formularies to gather and verify medication information for task-related requirements.
- Identified root causes of customer concerns, tracked resolution process steps, and documented all actions taken.
- Collaborate with appropriate staff to resolve a range of operational and organizational matters.
Lead Pharmacy Technician
Ralphs Pharmacy
05.2016 - 03.2025
- Collaborate with the staff pharmacist to ensure accurate typing, review, and dispensing of prescriptions.
- Lead and assist colleagues to ensure efficient workflow and adherence to protocols.
- Maintained and monitored excel spreadsheets to ensure accurate drug ordering.
- Maintain a clean and organized work environment.
- Provide excellent customer service and address inquiries efficiently.
- Assist in the training of new pharmacy technicians and provide feedback on their performance.
Sr. Pharmacy Technician
Optum RX
09.2023 - 02.2024
- Intake incoming calls from providers, pharmacies, and members to assist with everything prior authorization-related.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Provided guidance to providers regarding the prior authorization process.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Researched clinical criteria and plan formularies for requested services based on plan provisions.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
Subject Matter Expert /Prior Authorization Specialist
Prime Therapeutics LLC
02.2022 - 06.2023
- Collaborated with a direct supervisor to assist the team with any questions and additional assistance required in the prior authorization department.
- Worked on a solutions line to intake calls from fellow customer service representatives with any inquiries regarding prior authorizations.
- Worked on the inbound fax queue to complete fax prior authorization requests from providers and efficiently reviewed clinical information to make a decision for coverage.
- Provided subject matter expertise and guidance to cross-functional teams in the development of the prior authorization process.
- Analyzed existing processes and procedures to identify opportunities for improvement.
Education
La Serna High School
Whittier, CA06.2014
Pharmacy Technician License -
American Career College
Anaheim, CA06.2015
Skills
- Excellent and Effective Communication / Writing
- Exceptional Customer Service
- Multi-Task / Fast Paced Environment
- Conflict Resolution
- Pharmacy Operations
- HIPAA Guidelines and Regulations
- Escalations and SME Experience
- Compliance Training and Mentoring
- Excellent Team Collaboration
- Workflow Optimization
- Insurance Billing Systems
- PBM, Health Plan, and Clinical Setting
- Claim Analysis and Troubleshooting
- Quality Assurance
- Advanced Excel Knowledge
- Microsoft Office Tools
- Remote Environment
Certification
- Pharmacy Technician License - California State Board of Pharmacy
- Certified Pharmacy Technician - Pharmacy Technician Certification Board
Timeline
Sr. Pharmacy Resolution Specialist
Centene Management
04.2024 - Current
Sr. Pharmacy Technician
Optum RX
09.2023 - 02.2024
Subject Matter Expert /Prior Authorization Specialist
Prime Therapeutics LLC
02.2022 - 06.2023
Lead Pharmacy Technician
Ralphs Pharmacy
05.2016 - 03.2025
La Serna High School
Pharmacy Technician License -
American Career College