IKEOLA OMOLAYO

• Reviewed and resolved pharmacy appeals and grievances for denied prior authorizations and coverage determinations, evaluating clinical documentation, patient history, and evidence-based guidelines to determine medical necessity.
• Conducted thorough assessments of high-cost/specialty medication appeals, applying FDA indications, clinical policies, and biomedical literature to recommend approvals, alternatives, or upheld denials.
• Collaborated with medical directors, providers, and cross-functional teams to process appeals within regulatory timelines (e.g., CMS/NCQA standards) and ensure compliant, high-quality outcomes.
• Researched and synthesized pharmacotherapeutic evidence to support overturn decisions, contributing to improved patient access and appeal success rates.
• Managed daily appeals queues, tracked trends in denials/approvals, and participated in quality assurance and policy interpretation for medication utilization management.

• Oversaw team of 8 pharmacy technicians and clerks, scheduling, training, and mentoring
• Maintained patient safety record with 99.9% prescription filling accuracy rate
• Expanded immunization services and administered 500+ vaccines annually
• Per Diem

• Review and assess prior authorization requests for Medicare members, ensuring compliance with Medicare formulary guidelines and clinical criteria
• Collaborate with healthcare teams to assess and optimize drug therapy for Medicare members, improving health outcomes and medication adherence
• Provide clinical recommendations for appropriate medication use based on patient-specific needs, medical history, and Medicare regulations
• Support prior authorization processes and assist in resolving complex drug-related issues for Medicare patients
• Monitor and identify potential drug interactions or therapy gaps, communicating with prescribers to recommend adjustments as needed

• Review and interpret physician orders, ensuring the correct medications, dosages, routes are prescribed for each patient.
• Collaborate with healthcare teams to develop individualized medication management plans, ensuring patient safety and effectiveness of treatment.
• Verify medication orders for accuracy and appropriateness, including checking for drug interactions, allergies, contraindications, and duplicate therapies
• Investigate, document, and report any adverse drug events or medication incidents, following up with appropriate interventions to mitigate future risks.
• Overnight contract position

• Counseled patients weekly on medication uses, dosages, interactions, and side effects through one-on-one consultations
• Customized drug therapy plans for patients based on medical history and conditions to improve adherence and health outcomes
• Detected potential drug interactions for complex multi-drug regimens, recommending alternative therapies to doctors to reduce risk.
• Contract/Per Diem/Seasonal through Axion

• Review and evaluate 100+ medication prior authorization requests weekly ensuring formulary compliance
• Reduced processing time by 20% through workflow optimization and cross-training initiative
• Improved first-time auto-approval rate to 92% through enhanced assessment and communication protocols

• Counseled and educated 50+ diabetes patients weekly on medications and nutrition best practices
• Screened patients and recorded medical histories to effectively triage pharmacy service

• Verified 100% accuracy in prescription order filling through detailed patient profile reviews
• Resolved numerous daily insurance coverage issues to reduce rejected claims