Director of PA & Guide Operations at WithMe Health

• Apr 2021 - Present

Vice President, Clinical Operations

• Oct 2020 - Present

As VP of Clinical Operations, I establish relationships with vendors responsible for enrollment and eligibility systems, prescription claims, adjudication and member services; and execute processes and procedures. I directly supervise team members responsible for enrollment and disenrollment processes, as well as oversight of delegated functions. In 2021, I successfully drove Medicare application and enrollment processes, achieving 40K enrollments for a new national Medicare Prescription Drug Plan. I was also responsible for analyzing and approving the plan’s benefit design set-up by the PBM ensuring appropriate claims adjudication.

Director, Clinical Audit

• Jun 2015 - Oct 2020

As Director of Clinical Audit, I led clinical compliance focused audit services; developed compliance oversight of the Clinical Operations Department of the PBM ensuring regulatory and government guidelines were achieved; and fostered relationships between the Clinical Operations team of the PBM and compliance, resulting in the collaboration and creation of operational processes for development and improvement. In addition, I created an audit workflow process to improve efficiency; conducted audit training for operational leads and clients; and led mock audits for participant preparation. Working closely with clinical operations, I addressed audit findings and recommended remediation.

VP Pharmacy

• Apr 2012 - Jun 2015

As VP of Pharmacy, I developed and led action plans to implement new regulatory mandates and mitigation activities in collaboration with key stakeholders. I conducted continuous quality and compliance monitoring of key performance indicators, I contributed to the PBM’s pharmacy and therapeutics (P&T) committee review, consideration, and approval of medication use and drug formulary.

Director, Pharmacy

• Mar 2010 - Apr 2012

As Director, I played a key role in the development and implementation of a rules based clinical decision-making software to decrease coverage decision variability due to different clinical reviewers. This resulted in improved productivity and accuracy of decision making through automation. I also supported the RFP department with developing appropriate RFP responses based on operational procedure processes best suited to individual potential client needs.

Manager, Customer Service

• Jun 2007 - Mar 2010

As Manager of Customer Service, I developed staffing models to ensure service level obligations were surpassed for client contract guarantees.

Pharmacy Manager

• May 1999 - Jun 2007