Noura Khreis

Utilization Pharmacy Specialist @Health Alliance Plan

MI, US

As a Utilization Pharmacy Specialist for HAP Medicare, I play a critical role in optimizing drug therapy outcomes for our Medicare population by ensuring clinically appropriate, cost-effective, and evidence-based medication use. My work supports regulatory compliance, formulary management, and member health outcomes through the following responsibilities:* Perform clinical review of Medicare Part D prior authorization requests in alignment with CMS guidelines and HAP policies.* Evaluate drug utilization trends to identify opportunities for formulary optimization and cost-containment strategies.* Communicate directly with prescribers and healthcare providers to ensure appropriate use of medications and promote safe, effective therapy.* Collaborate with interdisciplinary teams, including Medical Directors, Case Managers, and Quality Improvement teams, to support member care plans.* Assist in the development and implementation of utilization management criteria and clinical guidelines.* Monitor and analyze pharmacy metrics and CMS Star Ratings to ensure HAP maintains high performance and compliance.* Support audit preparedness activities and assist in responding to CMS or internal compliance reviews.

Lebanese American University

Doctor of Pharmacy (Pharm.D.), Pharmacy

Madonna University

Master's Health Services Administration , Graduated with 4.0 GPA