Sean Laflamme
Clinical Operations Pharmacist
- Role
- Benefit Formulary Configuration Operations Pharmacist at AmeriHealth Caritas
- Location
- Philadelphia, PA, US
- LinkedIn followers
- 500 followers
About Sean Laflamme
Clinical Pharmacist with Pharmacotherapy, Geriatric, Wound Care & Palliative Care…
Experience
Benefit Formulary Configuration Operations Pharmacist
Jan 2023 — Present
Responsibilities:• Review clinical intent of change request form to ensure formularies will adjudicate at point of sale as expected• Works closely with claims processors to confirm that coding changes have been completed• Serves as the primary clinical point of contact for assigned lines of business which includes, but not limited to, coding based research and inquires, submission of coding to claim processor, validation of coding requests• Maintain plan formularies in claims processing systems • Serve as a lead for implementation for new lines of business and reimplementation for existing lines of business which includes, but is not limited to, establishing and testing adjudication rules, verifying benefit structure, and validating adjudication outcomes•Participates in client audits (Medicaid, Medicare, etc)•Develop business and operations processes for clinical programs related to Medicare, Medicaid, Commercial and Exchange lines of business through interpretation of formulary requirements (i.e, step therapies, quantity limits, opioid edits).•Supports the submission of assigned formularies to regulatory bodies•Represent the Clinical Operations department in multidisciplinary PerformRx meetings•Performs other job related duties and projects as assigned.
Education
Temple University School of Pharmacy
Doctor of Pharmacy (PharmD), Pharmacy
2007 — 2011
Temple University
Doctor of Pharmacy (PharmD), Pre-Pharmacy Studies
2004 — 2007
Skills
- Immunization
- Pharmaceutical Industry
- Clinical Research
- Clinical Pharmacology
- Pharmacy Automation
- Certified Immunizer
- Medication Therapy Management
- Patient Counseling
- Pharmacology
- Pain Management
- Diabetes
- Wound Care
- Clinical Pharmacy
- Palliative Care
- Nursing
- Community Pharmacy
- Compounding
- Healthcare
- Pharmacy Benefit Management
- Disease Management
- Prescription
- Pharmacists
- Pharmacy Practice
- Pharmacy
- Medicine
- Managed Care
- Pharmacueticals
- Medicare Part D
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