Manager of Care Management

• Aug 2022 - Present

Lead an interdisciplinary care team consisting of nurses, social workers, dietitians, pharmacists, and care coordination specialists to support the health plan's membership with the ultimate goal of increasing health outcomes for our members while decreasing cost for the organization. Facilitate relationships both within the organization as well as external provider and community partner organizations to ensure our members (patients) have safe, effective, accessible, and coordinated care through the health care ecosystem. Manage vendor relationships, budgets, education access and support, reporting processes, and team members. Show less

Ambulatory and Discharge Pharmacy Technician

• Jun 2021 - Aug 2022

Customer Implementation Manager

• Jul 2017 - Jan 2019

Leader in Technology Innovation and Implementation ● Manage implementation of internal and external client health plan products, provider networks and pricing structure, and new technology including gateway and cloud-based systems. ● Lead 36+ direct reports on multiple teams including union, non-union, and exempt employees. ● Coach and develop staff on career development, process improvement, meeting key metrics, and GROW coaching model. ● Project sponsor for implementation of new cloud-based technology via an Agile process. ● Utilize Lean Six Sigma principles to improve processes and procedures. Manager of Customer Implementation, concurrent role ● Built networks based on implementation requirements from internal provider, contract staff, and provider groups including working with external vendors for networks and pricing for non-network requests and exceptions. ● Audited and analyzed products and pricing to ensure accurate and timely processing according to requirements gathered. ● Implemented new technology and process improvements to increase timely filing and auto-adjudication metrics - lines of business: Family Care, Commercial, Self-Funded (ASO), Health Insurance Marketplace/Exchange (HIM/HIX). ● Synced and tested vended systems with internal systems to ensure accurate benefits are produced, creation of summary plan documents and web updates, and quality assurance testing on all product builds for existing and new clients of the health plan. ● Managed 19 direct reports from analysts to front end claims. Show less

Director of Pharmacy Services

• Apr 2016 - Jul 2017

● Managed 6-10 direct reports and over $30M budget covering administration, claims, programs, and educational needs.● Directed drug formulary management, philosophy, and strategy for multiple lines of business including group, commercial, ASO, and medicare.● Contracted with pharmaceutical manufacturers, pharmacies, and health care providers, managed Pharmacy and Therapeutics Committee (P&T) to ensure safety, efficacy, and cost-effectiveness.● Managed 10 Pharmacy Technicians, Pharmacists, and Nurse Specialty Case Manager on Medication Therapy Management (MTM) and PatientCentered Medical Home (PCMH) programs in collaboration with our clinic/hospital owner (Meriter) and practice agreement.● Built and maintained relationships with external clients, vendors, interdepartmental teams, providers, and members.● Recruited, facilitated, and oversaw Pharmacy and Therapeutics Committee.● Analyzed inter-departmental processes of benefits, claims, network, and contracting.● Acted as product owner for agile culture shift for originating implementation of cloud based technology to support provider enrollment and network execution. Show less

Pharmacy Operations Manager

• Mar 2015 - Apr 2017

● Designed, created, and coordinated multiple new lines of business in compliance with operational regulations.● Generated and presented analytical reports including financial, legal, operational, service level, and customer disruption.● Collaborated with internal and external stakeholders to create new workflows to optimize time management and external customer satisfaction.● Operational execution and coordination of Pharmacy and Therapeutics Committee● Managed 3-5 pharmacy technicians, call center, and additional operational staff and processes for entry and communication of all prior authorizations .● Made business decisions directing process timing, structure, information technology, and operational readiness. Show less

Pharmacy Operations Supervisor

• May 2013 - Mar 2015

● Coordinated and executed multiple new lines of business in compliance with operational regulations.● Acted as manager during open director position and implemented new PBM (Pharmacy benefit Manager) as well as manage staff and direct reports to Director of Pharmacy.● Supervised departmental staff of 5 coordinating operational activities including call center, claims, and production.● Made operational decisions regarding correction to files, claim processing, coordination of benefits, inter-departmental, internal, and external workflow processes.● Utilized committee feedback, corporate, and departmental philosophy to place medications on the formulary. Show less

Pharmacy Services Assistant

• Oct 2009 - May 2013

Answer calls from members and pharmacies with questions regarding our formulary, co-pays, and other pharmacy specific questions. Other paperwork including database upkeep and prior authorizations.

Senior Certified Pharmacy Technician

• Sep 2007 - Oct 2009

● Trained, scheduled, and coached staff on courses and training for PTCB certification exam. ● Managed medication inventory (Rx and PSE) and entered and filled prescriptions. ● Handled patient intake, medication reconciliation, medication stocking, and selling of Rx's meeting state board and legal standards/requirements. ● Trained, scheduled, and coached staff on courses and training for PTCB certification exam. ● Managed medication inventory (Rx and PSE) and entered and filled prescriptions. ● Handled patient intake, medication reconciliation, medication stocking, and selling of Rx's meeting state board and legal standards/requirements.