Barbara Anderson Email and Phone Number

Maintain research repository capturing utilization management requirements for medical and pharmacy including turnaround times, step therapy, exception requirements, formulary development, continuity of care, reporting and monitoringMonitor proposed state and federal laws, focused on utilization management, pharmacy benefit management (PBM) and plan developmentAdvise on pending and new legislation to articulate business landscape and capabilities, developing strategies to optimize United Health Group’s market positionReview and draft analysis of complex legislation impacting State, Federal, Medicare and Medicaid requirements and identify potential impact to assigned business partnersDocument, communicate and report on mandated benefits, identifying gaps and risk to ensure adherenceCollaborate with OptumRx, Health Plan state leads, legal and regulators to interpret mandates/regulationsCommunicate requirements impacting utilization review, Market Conduct Exams, ad hoc regulatory inquiries, data reporting and objectionsEstablish and manage business processes required to maintain relationships for services delegated to our PBM, behavioral health and medical delegatesIdentify and create policy and procedure development for new productsInitiate projects and provide Subject Matter expertise, creating new tools, research as appropriateDemonstrate and lead project management activities of applicable laws, regulations, mandatesCollect, coordinate and develop information for regulatory filings, reports and provide root cause analysis and resolution for nonstandard operational requestsMaintain utilization review licensure requirements and supporting policies and documentation.Ensure PBM delivery of network benefits with clear objectives, policies, standards, guidelines, and regulatory complianceDevelop prescription drug tables to assist in formulary tiering decisions and track mandated copaymentsEscalation liaison with PBM to ensure regulatory/data governance/man

Negotiate language for MSAs, NDAs, BAAs network rental, and reimbursement methodologiesSupport RFI / RFP and implementation initiatives in Medicaid, Medicare, and Commercial MarketsProject Management of Department of Veteran’s Affairs Community Care Behavioral Network (VACCN) Build $30B, WA 2019 $84M and 2020 $137M Integrated Medical Behavioral Medicaid NetworkPrepare memos, recommendations and offer variable language, risk assessment and drafting supportSupport provider credentialing, contracting, member materials and operations policy and procedure development to capture contractual and legal obligationsCollaborate and identify Mental Health Parity requirementsOnboard and Train coworkers on the integration of platforms, business processes and culture. Provided leadership to assure the professional/management growth at the individual level for direct reports to assure high performance and advancementCorporate Governance responsibilities for Directors and Officers and Entity Consolidation activities allowing integration of new businesses lines and reducing redundancy of licensesProvided litigation support with emphasis on cases involving ERISA, HIPAA, Benefit Plan, and class action.Managed litigation docket, case preparation and resource assignmentsAnalyzed and researched areas of non-compliance and implemented corrective action plansPrepared, coordinated, and presented research for policy and procedure implementationMonitored proposed state and federal laws. Developed communications on policy and regulatory activitiesProject manager for contract template and policy/process initiatives resulting in savings in excess of $12MBuilt processes to maintain, file, manage status of objections and approvals for licensesDevelop program/project scope statements, project charters, Statement of Work, Business Vision Documents in consultation with applicable stakeholdersWork with stakeholders to drive the identification of the resources, duration, obstacles and ef