Experience

Remedy Analytics

• United States
• Pharmaceutical Manufacturing
• 1 - 100 Employee

• Senior Clinical Director

  • Jan 2022 - Present

  Chicago, IL / Milwaukee, WI

• Clinical Director

  • Oct 2018 - Jan 2022

  Chicago, IL / Milwaukee, WI



Meridian

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Director of Regulatory Operations

  • May 2017 - Sep 2018

  Chicago, Illinois • Oversaw and supported all Medicare Part D, Medicaid, and Exchange PBM operations to ensure overall compliance with CMS guidance and state and federal legislation • Managed daily, monthly, and annual Part D, Medicaid, and Commercial formulary activities including development, submission, implementation and maintenance • Optimized the clinical quality and pharmacoeconomic performance of prescription benefits by employing data-driven analyses and evidence-based drug selection to achieve… Show more • Oversaw and supported all Medicare Part D, Medicaid, and Exchange PBM operations to ensure overall compliance with CMS guidance and state and federal legislation • Managed daily, monthly, and annual Part D, Medicaid, and Commercial formulary activities including development, submission, implementation and maintenance • Optimized the clinical quality and pharmacoeconomic performance of prescription benefits by employing data-driven analyses and evidence-based drug selection to achieve lower cost, improved member outcomes, and high levels of satisfaction among plan sponsors and membership • Subject matter expert and primary speaker during 2018 URAC Accreditation audit of Formulary, P&T Committee, and DrUM file review • Redeveloped P&T Committee through creation and implementation of Governance Charter and served as P&T Administrative Office Chair • Supported the Sales and Marketing team by providing clinical support in RFP responses and presentations to prospective clients • Actively participated in the Account Management team as the clinical consultant for internal/external clients to ensure strategic alignment, implementation, and on-going pharmacy benefit management • Developed in-house Medication Therapy Management and Medication Adherence Program to improve Medicare 5-Star performance • Assisted Fraud, Waste and Abuse (FWA) staff with the evaluation, data analysis, investigation, and ongoing monitoring of potential FWA • Communicated and aligned CMS regulatory strategy through partnership and collaboration with the Meridian Health Plan Compliance department and represented MeridianRx at regulatory meetings • Actively participated in the Michigan Department of Health and Human Services Pharmacy Director Subcommittee tasked to develop and maintain a Managed Care Organization common formulary • Developed affiliations with various allied organizations and coalitions with interest in regulatory matters affecting Meridian Health Plan and MeridianRx operations

• Manager of Clinical Operations

  • May 2015 - May 2017

  Detroit, Michigan • Oversaw Clinical Operations department consisting of fifteen pharmacists, two analysts, and ten technicians to deliver the highest quality of care through efficient staffing, continuous review and implementation of process improvement, and maintaining a high energy work environment • Complete oversight of all Medicaid, Commercial, and Medicare Part D clinical operations including coverage determinations, appeals, policy and procedure management, and overall compliance with state and… Show more • Oversaw Clinical Operations department consisting of fifteen pharmacists, two analysts, and ten technicians to deliver the highest quality of care through efficient staffing, continuous review and implementation of process improvement, and maintaining a high energy work environment • Complete oversight of all Medicaid, Commercial, and Medicare Part D clinical operations including coverage determinations, appeals, policy and procedure management, and overall compliance with state and federal guidance • Subject matter expert and primary speaker during 2016 Centers for Medicare and Medicaid Services (CMS) Part D Coverage Determination, Appeals, and Grievance (CDAG) Program Audit -Achieved perfect score of 0.00 • Clinical case reviewer and subject matter expert during 2016 and 2017 NCQA Survey of Medicaid and Commercial pharmacy denial and appeals file review • Participated in 2015 URAC Accreditation review and actively ensure compliance with regulatory and quality accreditation requirements • Directly oversaw Formulary Management Team and served as final clinical reviewer and quality assurance prior to submission to the Pharmacy and Therapeutics Committee • Actively contributed as a voting member of the Pharmacy and Therapeutics committee • Represented Meridian Health Plan at administrative state hearings as the subject matter expert • Developed Advanced Pharmacy Practice Experience (APPE) rotation program and precepted student pharmacists to develop a deeper understanding of managed care, pharmacotherapeutics and role within the medical management team • Provided clinical drug and disease information and educated providers, staff, and members • Oversaw the interdisciplinary care coordination team projects to assist with clinical drug and disease management programs and complex case review

• Clinical Team Lead

  • Jul 2014 - May 2015

  Detroit, Michigan



CVS Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Pharmacy Manager

  • Aug 2012 - Jul 2014

  Warren, Michigan • Communicated and achieved pharmacy key performance measure (KPM) goals by recognizing areas of opportunity through root cause analysis, action planning, and aligning my team through deep understanding of business operations • Developed, coached, and counseled pharmacy team composed of three pharmacists, two pharmacy interns, and fifteen pharmacy technicians • Interviewed potential talent, evaluated, hired, and managed team performance • Collaborated with other members of the… Show more • Communicated and achieved pharmacy key performance measure (KPM) goals by recognizing areas of opportunity through root cause analysis, action planning, and aligning my team through deep understanding of business operations • Developed, coached, and counseled pharmacy team composed of three pharmacists, two pharmacy interns, and fifteen pharmacy technicians • Interviewed potential talent, evaluated, hired, and managed team performance • Collaborated with other members of the healthcare team and provided pharmacotherapeutic recommendations • Provided patient counseling and drug utilization review to improve clinical outcomes • Improved overall patient satisfaction and team commitment to success • Implemented new techniques to improve KPM and served as district captain • 2013 Certificate of Excellence: Most Courteous and Professional Pharmacy rank in district of 17 stores Show less