Clinical Account Manager
Current• Consult with clients across multiple lines of business (Medicare, Exchange, and Commercial) to develop a trusting and confident partnership for client satisfaction.• Conduct regularly scheduled meetings with clients to ensure timely delivery of formulary and utilization management edits, adjudication of benefit edits functioning as expected; also ensure all enhancement and customization requests are being tracked w progress updates.• Manage and maintain multiple formularies, developed both internally and externally, through standard and customized drug lists using inclusion/exclusion criteria (i.e., Medispan GPI, FDB MEDID/ETC, NSDE NDC).• Perform HPMS formulary submissions using HPMS files.• Collaborate closely w MMIT to create and manage online formulary lookup tool and PDF documentation.• Work closely with Formulary Team, Benefits Management Team and client’s Clinical Team on how new formularies and utilization management edits will be built and the timeline for completion.• Perform member impact analysis on formulary and utilization management changes; communicate and review results with the client to determine implementation plan and member communication outreach. • Worked with Data Science engineer to produce CMS STARs compliant Medication Adherence and SUPD/SPC tool for real-time reporting; expanded tool for additional therapeutic classes for Commercial client use.• Assist the Benefits Management Team to clarify and test client’s clinical requirements on formulary and utilization management edits.• Assist the Formulary Team by applying clinical expertise and to create optimal formulary and utilization management edits. • Create process documents to ensure certain tasks can be reproduced efficiently and accurately (system work around/exception). • Attend quarterly P&T Committee meetings.• Perform coverage determination/prior authorization services.
