Celeste Calafiore Email & Phone Number

United States

Remote

Directly manages and supports a team of 9 Case Managers.Hosts weekly operational meetings with each Specialty Pharmacy partner regarding case escalations to ensure they are handled with urgency.Coaches team members and identifies areas for new training or skill checksAssists with hiring processes and Case Management trainingSupports team members by troubleshooting escalations.Performs quality assurance checks to identify opportunities to exceed our monthly targets.Communicates deadlines and goals to team membersDevelops strategies to promote operational excellenceDirectly monitors and facilitates all new patient starts, where Patient Services has been able to maintain a 50% start rate goal of consented patients in 2022.Quickly reports technological barriers to internal stakeholders. Participates in CRM meetings and strategizes improvements to CRM (including reporting) to ensure system is efficient for Case Managers and management team.Hosts 1 on 1 meetings with Case Managers to provide feedback, resolve issues, and assist with development and growth.Highly proficient in PowerPoint and Excel. Creates custom reports, pivot tables, and dashboards to monitor OKRs.

Remote

Directly manages and supports a team of 6 Case Managers.Supports associate director and performs management duties when manager is absent or out of officeProvides encouragement to team members, including communicating team goals and identifying areas for new training or skill checksAssists with hiring processes and Case Management trainingAnswers team member questions, helps with team member problems, and oversees team member work for quality assurance and guideline complianceCommunicates deadlines and goals to team membersDevelops strategies to promote team member adherence to company regulations and performance goalsAssists in weekly team meetings to update members on best practices and continuing expectations.Collaborates with Team Lead partner on maintaining and tracking New Patient Start forms to ensure we are meeting and exceeding monthly goals.Works with Team Lead partner on re-authorizations to ensure all Case Managers are receiving necessary information proactively to start at 60 day period.Identifies and communicates any technological barriers to internal stakeholders.Formally meets with Case Managers individually on a monthly basis to discuss quality assurance.Creates individual development plans for direct reports.Highly proficient in PowerPoint and Excel. Creates and updates reports geared to company goals on a daily basis.

South Plainfield, New Jersey

Philadelphia & Chicago Territory (NJ, PA, DE, IL, WI)Managed a caseload of approximately 240 DMD patients across 20-25 total accounts.Successfully converted a total of 15 PAP patients to commercial in 2020. Ended 2020 by utilizing expertise in External Appeals to convert all all PAP patients without prednisone history in the Philadelphia territory. Additionally at the end of 2020, successfully converted all bridge shipments in the Philadelphia territory to commercial for 3 months. Collaborates with RAMs on a weekly basis regarding case status updates and challenges. In addition, works with Market Access Team, Patient Engagement, and Medical Science Liaisons.Works to provide solution to bridge patients, PAP patients, reauthorizations, and low and late refills.Cultivates strong relationships with office contacts and provides support throughout PA/appeals process.Communicates with patients on a monthly basis to ensure compliance.Collaborates with Accredo, Orsini and Amber specialty pharmacy to facilitate the PA process.Chicago Successes: PAP conversions, able to completely eliminate five 1-month re-authorizations with Meridian Health Plan of IL by collaborating with offices on necessary testing. Collaborated with National Account Director/Medical Science Liaison for letter of medical necessity suggestions which aided PAP conversions.Strengths: OrganizationOverturning External Appeals - Especially with no prior step therapy history. Overcoming tough payer challenges and researches for future patients

Basking Ridge, Nj

CollaborationCollaborates with physicians to plan and implement patient care. In addition, I collaborate with Sales Team (TBMs/RSDs/RAMs) regarding case status updates and access solution challenges.Serves as a Specialty Pharmacy Liaison and collaborates with all 6 Specialty Pharmacies regarding case escalations.ReportingPrepares regular reports for 6 specialty pharmacies regarding case escalations (Accredo, CVS Caremark, Diplomat, Kroger, PantheRx, Walgreens)Patient CareDelivers compassionate care that exceeds requirements by serving as a single point of contact who manages the therapy cycle for each patient. This includes Benefit Investigations and Prior Authoirzations for onboarding patients, Appeals, Re-Authorizations, Late Refills, Low Refills, and ensuring a smooth patient experience with the Specialty Pharmacy. Familiar with Financial Assistance alternatives such as Patient Assistance and bridge programs for qualifying patients. Successfully managed quality care to 230 patients in Chronic Liver Disease in FL, TN, MI, WI.Reimbursement5 years of experience in reimbursement for specialty medications. Able to overcome challenges of cost and accessibility through the prior authorization and appeals process. Successfully able to overturn denials into approvals by ensuring all supporting documentation has been submitted to insurance. Familiar with other rejections (Cost Exceeds/Quantity Limit) and have collaborated with Specialty Pharmacies with my pharmacy expertise to overcome those rejections. Knowledgable in a range of pharmacy benefit plans and handles coverage barriers for Medicare Part D, Medicaid, and Commercial insurances.ImplementationImplemented a Welcome Call Letter for patients, caregivers, and healthcare providers to introduce Dova 1Source Case Managers as a single point of contact to access Doptelet and other hub benefits.Drug LaunchSuccessfully launched Doptelet, a specialty medication indicated for patients with Thrombocytopenia.

Somerset, Nj

Patient Care Coordinator knowledgable in several departments and assisted cross-departamentally.Patient CareWorked with a common condition of Infertility. Patient-focused coordinator who empathized with patients and understands the importance of sensitivity. Familiar with medications for IUI, IVF, Frozen Embryo Transfer, Donor, and Gestational Carrier cycles in addition to Pregnancy sustaining medications. Able to work on a minimum of 60 patients daily, and have made an average of 400 patient outbound calls a week (highest) including creating patient profiles, initiating Prior Authorizations/Triaging prescriptions if needed, communicating with HCPs on patient prescription statuses, and handling shipping and payment.ReimbursementTypically, fertility medications are a high-tier specialty medication and are difficult for most insurances to cover. Handled reimbursement for Commercial patients on a range of fertility medications. Must be familiar with directions of use, dosage form, quantities, diagnosis, and prior patient history for coverage determination. TrainingDesignated trainer to train staff members for Reception, Intake department, Outake department, and Prior Authorization department as well as cross-departmentally. ImplementationCollaborated with the Intake Supervisor to create an effective follow-up system to achieve faster turnaround times. Collaborated with the Processing Manager on department improvements.

Somerset, New Jersey

ReimbursementTypically, fertility medications are a high-tier specialty medication and are difficult for most insurances to cover. Handled reimbursement for Commercial patients on a range of fertility medications. Must be familiar with directions of use, dosage form, quantities, diagnosis, and prior patient history for coverage determination. Patient CareInitiated and Completed an average of 30-40 Prior Authorizations/Triages daily. Advised patients of Prior Authorization statuses and communicated with HCP offices of Prior Authorization Requirements. Triaged prescriptions that are "out of network" and require to be filled with a specialty pharmacy contracted with their Pharmacy Benefit Manager. Provided out-of-pocket price quotes to cash-paying patients and informed cash-paying patients of financial assistance programs that we participate with. Billed claims for financial assistance patients who have been approved.

Somerset, Nj

Patient CareThoroughly reviewed orders for discount programs, shipping, and any additional fees that may be incurred. Scheduled shipment and collect payments in a professional manner. Able to assess the correct identity, strength, and storage of medications and acted as a liaison for patients by communicating with other departments concerning the billing of medications.

Bridgewater

Promoted to Beauty Studio Coordinator from Beauty Coach (June 2013- July 2016)Boosted Beauty Studio Sales an average of 50% in both Q3/Q4, with overall sales starting at 18% and ending at 27% (Goal: 25% of Sephora's Business).Ranked #1 in Sales for 2016 Regional Skin Care Contest.Ranked #1 in Sales for 2016 Regional Sephora Collection Contest.Awarded Employee of the Month August 2016 for “Taking Initiative” and “Innovation” as the new beauty studio coordinator (captain) who implemented new ways of sales techniques.Awarded Employee of the Month March 2014 for Taking Initiative and going above and beyondSuccessful in my leadership by celebrating appreciation and encouraging team culture, setting goals and facilitating for results, and strengthening team capabilities.

Business Administration And Management, General

Associate Of Arts - Aa, Liberal Arts And Sciences/Liberal Studies