Alan Bayham

Alan Bayham Email and Phone Number

AVP, Medical Affairs, Ochsner Health Plan @ Ochsner Health Plan
New Orleans, Louisiana, US
Alan Bayham's Location
Madisonville, Louisiana, United States, United States
Alan Bayham's Contact Details

Alan Bayham personal email

n/a
About Alan Bayham

Alan’s managed care experience includes Self-Funded Employer health plans, Commercial health plans, Managed Medicaid health plans, Medicare-Advantage health plans, and working with Provider Groups that are globally capitated or that are at risk for medical and pharmacy services, including Quality Measures and Star Ratings. In fact, he has spent the last 20 years in managed care as a director and vice-president over such pertinent functions as Member Services, Appeals and Grievances, Patient Safety, Compliance, Accreditation, Pharmacy Services, Medical Management, Quality Improvement, and Utilization Management. Alan had worked with health plans from Puerto Rico to the Canadian border and from the Atlantic Ocean to the Pacific Northwest. He has successfully helped health plans in all stages of their life cycle: from conception, funding, planning, development, and implementation to management and operations, including merger and transition to close out and shut down.

Alan Bayham's Current Company Details
Ochsner Health Plan

Ochsner Health Plan

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AVP, Medical Affairs, Ochsner Health Plan
New Orleans, Louisiana, US
Employees:
31
Alan Bayham Work Experience Details
  • Ochsner Health Plan
    Avp, Medical Affairs
    Ochsner Health Plan Jan 2021 - Present
  • Ochsner Health System
    Pharmacy Program Manager, Ochsner Health Network
    Ochsner Health System Jan 2017 - Jan 2021
    Ochsner Health Network - Elmwood
    1. Formulary development and management for Ochsner Health Network (OHN)
.2. Pharmacy Benefit Management; Organizational liaison with third party administrator (PBM).3. Drug Information resource for providers and prescribers
.4. Chair of Pharmacy and Therapeutics Committee (P&T).
  • Bayham Consulting, Llc
    President
    Bayham Consulting, Llc Mar 2006 - Jan 2017
    Louisiana, Ohio, Virginia, New Jersey, Oregon, And Elsewhere
    • Leadership role in many functional areas of Health Plan Management resulted in meeting all goals, budgets, and deadlines while also increasing employee satisfaction and reducing employee turn-over.• Awarded CMS/HHS contract for new Medicare-Advantage Plan.• Awarded multi-million dollar loan grant from CMS/HHS for multiple new Health Cooperatives (health plans) as part of the Affordable Care Act (ACA).• Obtained various health plan licenses by working effectively with several State Departments of Insurance.• Successfully met all CMS/HHS implementation milestones within budget, while meeting national deadline for new Medicare-Advantage Plan.• Effectively met all CMS/HHS implementation milestones within budget, while meeting national deadlines for new Health Care Co-Op on Federally Facilitated State Exchange.• Achieved successful start-up of new plans or new vendors for existing plans without incident.• CMS audits of responsible functional errors never received any deficiencies.• Obtained New Health Plan (NHP) accreditation from the National Committee on Quality Assurance (NCQA) with near perfect score (>99%).• Assisted various new Health Plans receive Qualified Health Plan (QHP) designation from CMS/HHS as required by the ACA within budget and national deadlines.• Developed and successfully implemented new Asthma Medication Treatment Program for large “at risk” Integrated Health System.• Developed and successfully implemented new Clinical Pharmacy “Anti-Detailing” Program for large Medicare-Advantage Health Plan.• Developed and successfully implemented new Generics Alternatives program for large “at risk” Integrated Health System that increased the Generic Dispensing Rate from 70% to 90%.• Conducted Pharmacy Benefits Manager RFPs for several health plans (Commercial, Medicare-Advantage, and Medicaid) that resulted in millions of dollars in savings per year at each plan.
  • Peoples Health
    Director, Pharmacy And Member Services
    Peoples Health Dec 2002 - Mar 2006
    Greater New Orleans Area
    Director of Pharmacy Services Staff (Operations and Clinical), Director of Member Services (Operations, Appeals, Grievances, and Complaints). Meet all Federal and State regulations, as well as Accreditation standards. Managed staff. Planned, directed, and monitored all financial, operational, professional, and clinical activities of Pharmacy Programs in accordance to federal and state laws.
  • Ochsner Health Plan
    Pharmacy Director
    Ochsner Health Plan Mar 1999 - Dec 2002
    Greater New Orleans Area
    Director of Pharmacy Services Staff (Operations and Clinical), Meet all Federal and State regulations, as well as Accreditation standards. Managed staff. Planned, directed, and monitored all financial, operational, professional, and clinical activities of Pharmacy Programs in accordance to federal and state laws.
  • Pontchartrain Pharmacy
    Chief Consultant Pharmacist
    Pontchartrain Pharmacy Jun 1998 - Mar 1999
    Louisiana
    Operations and Dispensing. Patient chart reviews in various nursing homes across Southeast Louisiana. Managed Pharmacists and Pharmacy Technicians. Planned, directed, and monitored all operational, professional, and clinical activities of Clinical Pharmacist Programs in accordance to federal and state laws.
  • Abbott Laboratories
    District Specialist/Medical Liaison/Long-Term Care Specialist
    Abbott Laboratories Sep 1978 - Jun 1998
    Louisiana
    Develop key opinion leaders, conduct medical research to submit to FDA, service retail, hospital, and LTC pharmacies.
  • Montelepre Memorial Hospital
    Chief Pharmacist And Pharmacist-In-Charge
    Montelepre Memorial Hospital Jul 1976 - Sep 1978
    Greater New Orleans Area
    Planned, directed, and monitored all financial, operational, professional, and clinical activities of Pharmacy Programs in accordance to federal and state laws. Dispensing. Pharmacist in charge. Managed staff.
  • Grun'S Drugs
    Vice-President/Store Manager/Pharmacist-In-Charge
    Grun'S Drugs Sep 1972 - Jul 1976
    Greater New Orleans Area
    Planned, directed, and monitored all financial, operational, professional, and clinical activities of Pharmacy Programs in accordance to federal and state laws. Dispensing. Pharmacist in charge. Managed staff.

Alan Bayham Skills

Managed Care Healthcare Medicaid Disease Management Medicare Health Policy Health Insurance Hipaa Pharmacy Benefit Management Utilization Management Medical Billing Healthcare Industry Healthcare Management Pharmacy Healthcare Information Technology Insurance Leadership Quality Improvement Strategic Planning Healthcare Consulting Management Physicians Credentialing Ncqa Provider Network Development Start Up Consulting Formulary Medicine Business Process Improvement Patient Safety Process Improvement U.s. Health Insurance Portability And Accountability Act Healthcare Information Technology Pharmacists Operational Planning Business Launch Project Management Appeals Grievances Data Analysis Microsoft Excel Microsoft Word Powerpoint Formulary Management Medication Therapy Management Pharmacy Consulting Change Management Program Management Team Management

Alan Bayham Education Details

Frequently Asked Questions about Alan Bayham

What company does Alan Bayham work for?

Alan Bayham works for Ochsner Health Plan

What is Alan Bayham's role at the current company?

Alan Bayham's current role is AVP, Medical Affairs, Ochsner Health Plan.

What is Alan Bayham's email address?

Alan Bayham's email address is al****@****ing.com

What schools did Alan Bayham attend?

Alan Bayham attended University Of Phoenix - Metairie, Louisiana Campus, Xavier University Of Louisiana.

What skills is Alan Bayham known for?

Alan Bayham has skills like Managed Care, Healthcare, Medicaid, Disease Management, Medicare, Health Policy, Health Insurance, Hipaa, Pharmacy Benefit Management, Utilization Management, Medical Billing, Healthcare Industry.

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