Experience

ATTAC Consulting Group (ACG)

• Consultant

  • Aug 2012 - Present

  Expertise in Medicare Part D clinical programs: Formulary, Medication Therapy Management; systems and operations. Experience forte' in the conception, construction and execution of high quality clinical programs and processes with measureable outcomes and increased process efficiencies.Strong skills sets in clinical trend and analysis, creative problem solving to evolve and improve existing processes and systems in Formulary, Fraud and Compliance, DUR, clinical programs, Medication Therapy… Expertise in Medicare Part D clinical programs: Formulary, Medication Therapy Management; systems and operations. Experience forte' in the conception, construction and execution of high quality clinical programs and processes with measureable outcomes and increased process efficiencies.Strong skills sets in clinical trend and analysis, creative problem solving to evolve and improve existing processes and systems in Formulary, Fraud and Compliance, DUR, clinical programs, Medication Therapy Management and data validation auditing for Medicare Part D programs as well as Qualified Health Plan / Exchange Formulary development. Show more Show less



ACCESS1

• Senior Associate Consultant

  • Mar 2012 - Present

  ACCESS1 is an IT firm specializing in design and development of secure, complex programs and systems for highly regulated healthcare business environments. www.access1.bizSenior Associate Consultant applying pharmacy and healthcare expertise to logic development and the design of customized systems to transform business complexities into business simplicities through innovative system design to include pharmacy components of EPIC transitions, ACO and health system upgrades.



Vernachio Managed Care Consulting, LLC

• President

  • Aug 2011 - Present

  Providing high quality, customer focused consultative services in the managed care pharmacy environment. Areas of expertise include: Medicare Part D • Medication Therapy Management • Formulary development, management and operations• Fraud, waste and abuse• Medicare clinical programs• Drug utilization and review• Star Ratings• Pharmacy trend and analysis



Aetna

• Department Owner - Formulary Development & Strategy- Medicare

  • 2009 - 2011 2 years , Alpharetta, Georgia , End to end ownership of all aspects of Medicare Formulary; formulary competitive analysis, utilization trend and analysis. Scope of management includes formulary development, management and operations, oversight of formulary-related programs, publications, drug utilization; fraud, waste & abuse; point-of-service edits and messaging.Maintain strong collaborative relationships with Manufacturer Contracting and Health Economics.

• Clinical Services Manager

  • 2006 - 2009 3 years , Alpharetta, Gerogia , Development of Medication Therapy Management Program (MTM) for Medicare D benefits. Oversight of MTM operations, clinical programming, CPhT and CM activities within MTM program. Utilization & Clinical Trends Analysis for strategic development of MTM program. MTM program database development & management. Communication strategy development to physicians, members or caregivers. Collaboration on Medicare product development & strategy, formulary, program policy and procedures. Evaluation… , Development of Medication Therapy Management Program (MTM) for Medicare D benefits. Oversight of MTM operations, clinical programming, CPhT and CM activities within MTM program. Utilization & Clinical Trends Analysis for strategic development of MTM program. MTM program database development & management. Communication strategy development to physicians, members or caregivers. Collaboration on Medicare product development & strategy, formulary, program policy and procedures. Evaluation, negotiation & selection of vendor/supplier of Medication Therapy Management Services (2010).



Aetna

• Regional Pharmacy Director

  • 2003 - 20052 years

  Regional oversight of pharmacy operations, clinical Programs, pharmacy representation for QA / UM / CQI / NCQA. Utilization & clinical trends analysis. Communication of benefit design, facilitation of product installation. Benefit analysis to regional and national clients. Collaboration with sales & marketing for client retention renewal & prospecting. Collaboration with sales & underwriting teams in response to RFP requests. Provision of clinical information and consultation for complex case… Regional oversight of pharmacy operations, clinical Programs, pharmacy representation for QA / UM / CQI / NCQA. Utilization & clinical trends analysis. Communication of benefit design, facilitation of product installation. Benefit analysis to regional and national clients. Collaboration with sales & marketing for client retention renewal & prospecting. Collaboration with sales & underwriting teams in response to RFP requests. Provision of clinical information and consultation for complex case management, medical – legal review and appeals. Show more Show less



TAP Pharmaceuticals

• Medical Education & Research Liaison, Managed Care-East

  • 2002 - 20031 year

  Responsibilities and Achievements:The provision of clinical information, resources and related research for all products within the TAP Pharmaceuticals portfolio to managed care clients. Development of Medical Affairs operating infrastructure and procedures. Collaborative development of Product Formulary Dossiers. Development of Medical Education programming. Collaboration with sales and sales training on medical and product education. Cultivation and maintenance of key though leader /… Responsibilities and Achievements:The provision of clinical information, resources and related research for all products within the TAP Pharmaceuticals portfolio to managed care clients. Development of Medical Affairs operating infrastructure and procedures. Collaborative development of Product Formulary Dossiers. Development of Medical Education programming. Collaboration with sales and sales training on medical and product education. Cultivation and maintenance of key though leader / investigator relationships, clinical leadership within accounts and with key professional associations. Function as experienced resource for managed care clinical evaluation and pharmacy operations for internal and external customers. Cultivation and development of investigator initiated research in Health Economics, Outcomes and Productivity research. Provide presentations to internal and external customers regarding clinical and managed care issues. Show more Show less



AstraZeneca

• Clinical Liaison

  • 1999 - 20023 years

  Responsibilities and Achievements:The provision of clinical information and resources for all products within the AstraZeneca portfolio. Facilitation of product messaging to field sales as applied to the managed care account benefits. Collaboration with Therapeutic Area Information Scientists in support of field sales efforts regarding managed care messaging and obstacle handling. Therapeutic strengths include Respiratory, GI and Cardiovascular. Development of clinical strategy within the… Responsibilities and Achievements:The provision of clinical information and resources for all products within the AstraZeneca portfolio. Facilitation of product messaging to field sales as applied to the managed care account benefits. Collaboration with Therapeutic Area Information Scientists in support of field sales efforts regarding managed care messaging and obstacle handling. Therapeutic strengths include Respiratory, GI and Cardiovascular. Development of clinical strategy within the Account Business Plan in coordination with National Account Directors. Cultivate and maintain relationships with key national customers and provide expertise and assistance in the development / management of clinical partnerships and programs with customers. Provide teaching and lecturing skills to internal and external customers regarding clinical and managed care issues. Show more Show less



East Bay Medical Network

• Director of Pharmacy

  • 1997 - 19992 years

  Responsibilities and achievements:Development and implementation of a Pharmacy risk management for a physician-owned medical service organization (MSO) with 10+ Health Plan lines of business. Development and management of Pharmacy and Therapeutics Committee, “Preferred Medications” list, Drug Usage Guidelines, and therapeutic algorithms. Contributing authorship to MSO disease management manuals. Negotiation and execution of contractual elements of pharmacy-related services and risk… Responsibilities and achievements:Development and implementation of a Pharmacy risk management for a physician-owned medical service organization (MSO) with 10+ Health Plan lines of business. Development and management of Pharmacy and Therapeutics Committee, “Preferred Medications” list, Drug Usage Guidelines, and therapeutic algorithms. Contributing authorship to MSO disease management manuals. Negotiation and execution of contractual elements of pharmacy-related services and risk arrangements. Collaborative development of standards of practice (SOP) for drug claim verification, payment, vendor contracting; SOPs for benefit verification, authorization and acquisition of pharmaceuticals (both medical and pharmacy benefit) and related services. Collaborative management with QA / UM departments on high-risk case management, review and standards of practice. Development and management of network for specialty medications and diabetic supplies. Development of pharmacy claims database and data query application. Development of standardized pharmacy reporting to include: finance, utilization & trend analysis, network physician reports, and medical director reports. Development of a disease cost burden model utilizing pharmacy data. Development of disease and drug related educational programming for patients and physicians. Show more Show less



FHP Healthcare, Inc

• IPA Clinical Pharmacist

  • 1996 - 19971 year

  Responsibilities and Achievements: Develop strategies for cost containment and management of twenty one independent physician association (IPA) pharmacy risk funds. Member of Joint Operations Committee for twenty one contracted medical groups.Management of IPA programs to include: pharmacy claims processing, outcome analysis, pharmacoeconomic & trend analyses, case management committee, and provision of clinical information, resources and programs. Compliance with HCFA / HEDIS /… Responsibilities and Achievements: Develop strategies for cost containment and management of twenty one independent physician association (IPA) pharmacy risk funds. Member of Joint Operations Committee for twenty one contracted medical groups.Management of IPA programs to include: pharmacy claims processing, outcome analysis, pharmacoeconomic & trend analyses, case management committee, and provision of clinical information, resources and programs. Compliance with HCFA / HEDIS / FDA regulations and related reporting. Member of California Pharmacy and Therapeutics Committee for FHP Healthcare, Inc. w/ related development of DUEs & DUGs for application to the FHP Medicare pharmacy benefit. Supervision of Prior Authorization technical staff. Development of new member orientation program for Medicare advantage products. Education of physicians, members, sales/marketing staff pharmacy to pharmacy policy and benefit. Coordination with plan administration on contract negotiation and administration with medical groups. Coordination with Pharmacy Administration in the execution of manufacturer contracts. Show more Show less



Veterans Health Administration Medical Center

• Surgical Critical Care Specialist

  • 1992 - 1996 4 years , Long Beach, California , Responsibilities and Achievements:Therapeutic consultation for Surgical and Anesthesia services with active involvement in decision-making, dosing, evaluation and monitoring. Patient discharge interview and counseling. Pharmacokinetic monitoring of parenteral / enteral nutrition, and medication. Management of surgical services pharmacy budget, utilization and outcomes in the ICU setting. Teaching responsibilities to medical residents & students, nursing staff, pharmacy residents and… , Responsibilities and Achievements:Therapeutic consultation for Surgical and Anesthesia services with active involvement in decision-making, dosing, evaluation and monitoring. Patient discharge interview and counseling. Pharmacokinetic monitoring of parenteral / enteral nutrition, and medication. Management of surgical services pharmacy budget, utilization and outcomes in the ICU setting. Teaching responsibilities to medical residents & students, nursing staff, pharmacy residents and students. Preceptorship of pharmacy and medical Students. Research responsibilities include preceptorship of resident research projects and investigational and clinical data collection. Administrative responsibilities include service to JACHO committe; CQI & QA multidisciplinary committees, DUE, P&T Committee. Supervision of surgical services pharmacy, technical staff, dispensing and order entry.

• Clinical Pharmacist - Critical Care

  • 1991 - 1992 1 year , Augusta, Georgia Area , Responsibilities and Achievements: Part-timeTherapeutic consultation in ICU setting, with active involvement in decision-making, dosing, evaluation and monitoring. DUE development. . Pharmacokinetic monitoring of parenteral / enteral nutrition, and medication. Patient discharge interview and counseling.Teaching responsibilities to medical residents & students, nursing staff, pharmacy residents and students. Supervision of ICU pharmacy, technical staff, order entry and dispensing.