iNIVativeRx

Chief Pharmacy Officer-BenMedica

Pharmacy Consultant

Independent Health

Ensured safe medication use for 375,000 member lives and compliance with accreditation/regulatory requirements for NCQA and US Department of Health & Human Services, Center for Medicare and Medicaid Services. Handled program strategic planning, reporting, integration and collaboration. Identified process and benefit coordination improvements related to DUR and UM programs. Coordinated with different departments regarding member, prescriber and pharmacy overutilization of drugs of abuse. Active member of Pharmacy Quality Assurance Team and Pharmacy Trend Team.  Actively supported Pharmacy and Therapeutics Committee. Performed quarterly reviews for CMS overutilization monitoring program. Wrote communications to physicians, members and pharmacists through corporate publications and educational mailings.

Implemented pharmacy claims system edits such as drug-drug interactions, therapeutic duplication, maximum daily doses and messaging capabilities.  Organized and set-up Annual Continuing Education programs for primary care prescribers and pharmacists on the appropriate prescribing of opioids. Actively participated on the Erie County Opioid Task Force to implement programs in our community.  Led the DUR Board; provided oversight of drug utilization patterns (prior authorization requests, drug spend, denied claims, paid amount and drugs by count of claims in addition to quarterly formulary reviews). Provided active support for community wide drug take-back programs to address the opioid overdose epidemic, partnering with the DEA, Department of Health, local law enforcement, and Schools of Pharmacy.  In 2017 implemented high dose thresholds on opioid medications in the Medicare line of business.

Drug Utilization Management

Oversaw the prior authorization process for an HMO serving 350,000 commercial, Medicare and Medicaid members. Acted as an interface with physicians and pharmacists with respect to beneficiaries' benefits and therapeutic interventions. Assisted in formulary management; supported Pharmacy & Therapeutics Committee, communicated with physicians and pharmacists as well as with staff on departmental policies and procedures.  Implemented requirements necessary to gain NCQA accreditation and federal and state requirements necessary to ensure regulatory compliance.  Provided clinically sound programs and access to medications in the most cost-effective manner and utilization of technology to implement on-line programs.

Prior Authorization Pharmacist - Clinical Review Pharmacist

Walmart

Provided professional pharmacy services to build clientele for 4 new stores in the Buffalo area; dispensed prescription medications, consulted with physicians and patients, completed insurance paperwork, supervised other pharmacy staff and counselled patients on drug and other health-related topics. Utilized pharmacy computer systems for processing prescriptions and insurance claims.

Staff Pharmacist

I am a pharmacy consultant with extensive expertise in the healthcare industry.  I understand the business of pharmacy and how decisions made at a corporate level can impact and affect the daily health of large populations.  With this knowledge I advocate for the following sectors: 
 
1. Individual patients:  Providing medication management and help navigate the healthcare system to enhance patient well-being. 
2. Health plans: Leverage competitive strategies.
3. Healthcare systems: Reduce redundancy and improve efficiency.
4. Employer groups: Ensure high quality healthcare is delivered cost-effectively and enhances the health and employee well-being.
5. Prescribers: Enhance clinical outcomes and productivity of the medical office by alleviating unnecessary time strains.

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Nivedita Kohli, RPh, MPBA (She/Her)'s Linkedin Analytics

Nivedita Kohli, RPh, MPBA (She/Her)

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