Clayton Edwards's Location
Orlando, Florida, United States, United States
Clayton Edwards's Contact Details
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About Clayton Edwards
Thanks for visiting my profile; conversations welcome.The healthcare marketplace is complicated; but simultaneously dynamic and a target rich environment for innovation to enable collaboration across the value chain that delivers improved outcomes.It's easy to get lost in the complexity and lose sight of the purpose and people, the individuals who deliver and support the systems and all of us, the patients whose lives depend on it.My commitment is to stay focused on outcomes – for patients, for providers, support and administrative staff and to do this profitably, so our health systems are sustainable, efficient and continuously improve quality of care and life.Stakeholder Value Creation – My goal is to envision the possible then grow the business through people, processes, and technologies; align the goals of practitioners, consumers, payers, and suppliers to increase value for each constituent.Strategic Growth Initiatives – Led creation and execution of sales, marketing, and clinical strategies generating $8B in new sales, built strong customer relationships resulting in 98.5% retention and 10-point NPS improvement.Global Leadership – Led global staff of over 6,000 professionals in 27 domestic and 4 off-shore locations.STRATEGIC PLANNING & EXECUTIONDe Novo Growth Strategy & CommercializationTop- & Bottom-Line GrowthMergers & Acquisitions (M&A)Strategic Partner RelationshipsCustomer ExperienceBUSINESS DEVELOPMENTRevenue AttainmentChannel OpportunitiesCustomer Expansion & Retention Market Trends, Demographics & InnovationsSales Execution & IncentivesOPERATIONAL EXCELLENCEFull P&L ResponsibilityOperational Controls & KPIsOrganizational Effectiveness & ProductivityTurnaround & Risk ManagementLegal & Regulatory CompliancePlan vs. Actual ReviewsCULTURE & TEAM BUILDINGHigh-Performing TeamsMetrics-Driven CultureService & AccountabilityProfessional DevelopmentTECHNOLOGY & INNOVATIONQualitative & Quantitative AnalysisPractice Management/EMR SystemsRobotic Process AutomationWeb & Mobile App Development
Clayton Edwards Work Experience Details
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Senior Vice PresidentAscellahealthOrlando, Fl, Us -
PresidentRhema Healthcare Consulting 2010 - PresentStrategic consulting company specializing Medicare Part D, Medicare Advantage, Health Plans and Pharmacy strategic plan development and implementation focused on new product development, member growth, enhanced access and operational excellence.• Client services include: process reengineering, call center optimization, new product development; VIPPS, URAC, NCQA, JACHO accreditations; retail, specialty, mail order, 340B and compounding pharmacy; durable medical equipment; and business and consumer marketing strategies. • Clients include: Medicare/Medicaid service providers, Direct to Consumer marketing firms, pharmacies, global dialysis company, Health Plans and DME providers.
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Chief Operating OfficerAlliancerx Walgreens Prime 2019 - 2022Deerfield, Il, UsCurrently serve as chief operating officer at AllianceRx Walgreens Prime, one of the largest specialty and home delivery pharmacies in the country. Based in Orlando, the company has more than 4,000 team members in nine locations across the country. In this role, I lead the organization’s enterprise operations comprised of nearly 80% of the work force. Operations include specialty and home delivery operations; business innovation and advanced therapies; facilities management, logistics and engineering; service delivery and ops excellence; plus operations planning and execution. -
Senior Vice President Of PharmacyCaresource Jan 2019 - Oct 2019Dayton, Oh, UsNationally recognized not-for-profit health plan serving two million members across Medicare, Medicaid and Marketplace programs. -
Chief Operating OfficerImprimis Pharmaceuticals, Inc. 2016 - 2017Carlsbad, California, UsRecruited to lead overall strategy, execution, and profitability of the company including IT, Call Center Operations, Professional Practice, Quality Assurance, Manufacturing, Dispensing and Supply Chain. Developed and nurtured strategic client, partner and vendor relationships in development of new products/services and revenue growth.• Decreased operations cost by 61% and increased efficiency by 124% through optimizing IT and operations, implementation of executive dashboards to drive accountability and remote site consolidation. • Launched new 503B Outsourcing Facility with six key sterile ophthalmology products positioning company for strategic growth in this high-margin category. • Realized product roadmap to sustain ongoing revenue by commercializing 17 new drug formulations.• Established comprehensive goals and performance KPIs ensuring FDA compliance with 21 C.F.R. – Parts 210-211 & Part 820, and U.S. Pharmacopeia <795> and <797> rules. NOTE: Sudden health crisis and subsequent death of aging parent necessitated resignation in order to fulfill executor/estate responsibilities and establish surviving spouse in stable living arrangements. Resumed career focus in July 2018. -
Senior Vice President Broker & Employer OperationsUnitedhealth Group 2015 - 2016UsTransitioned to lead key segment in UHC’s overall strategy with responsibility for over $40B revenue and $300M budget for UnitedHealthcare’s commercial health and specialty benefit insurance operations. • Led global staff of over 3,500 professionals in eight domestic and three off-shore locations responsible for proposals, contract management, new account installation, and dedicated client success team for management of contracted health services.• Achieved a $40M savings through a 25% process improvement initiative across all benefit configurations, installation and contracting areas, necessitated by a 200% sales increase beyond forecast. Introduced machine learning automated solution ensuring all new client enrollment was completed accurately and on schedule. -
Senior Vice President Optumrx Specialty And Home Delivery Pharmacy, Prior Authorization & AppealsUnitedhealth Group 2011 - 2015UsRecruited to lead this multibillion-dollar segment of UnitedHealth Group with responsibility for growth, effectiveness and financial performance. Developed and implemented strategies to improve the financial infrastructure, enterprise-wide information technology and robotic systems, overall productivity and member clinical outcomes of the Specialty, Home Delivery and Prior Authorization departments. Enhanced drug access through improved benefit designs and Pharma negotiations. Led the development and execution of Specialty Pharmacy patient clinical education and ongoing monitoring. Represented company in escalated client issues and Best-and-Final customer presentations and contract negotiations. • Achieved 23% CAGR by managing $34B revenue and $350MM budget with full P&L responsibility.• Led global staff of over 6,000 professionals in 27 domestic and four off-shore locations.• Achieved 10-point improvement in Net Promoter Score by negotiating better service guarantees from vendors, system enhancements, and improving clinical communications to members.• Implemented machine learning solution to process electronic prescriptions yielding 600% improvement in first pass accuracy while reducing $26MM in annual labor cost and eliminating translational errors. • Developed robust Medication Quality Assurance program and improved dispensing quality by 93% DPMO (5.4 sigma to 6.0 sigma) on more than 32 million annual prescriptions dispensed.• Led the nation’s largest prior authorization, appeals and home delivery pharmacy programs for Medicare Part D Plans, making determinations on over 6 million receipts for 39 million members.• Increased STARS score one full star by eliminating 88% of customer complaints, reducing overall complaints to Medicare by 35% in the first year and to virtually zero in four years by improving communications, internal processes and systems.• Developed and implemented new products/programs generating $500M of new high margin revenue.
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Senior Vice President, Chief Pharmacy OfficerDoctor Diabetic Pharmacy, Inc. 2010 - 2011Joined this high-potential spinoff from Doctor Diabetic Supply (DBS), a direct-to-consumer provider of diabetes testing supplies serving 120K patients. Serviced the pharmacy needs of DBS’s Medicare population and positioned the company for acquisition. Developed and implemented start-up pharmacy business plan, three-year forecast, enrollment and marketing strategy. • Pharmacy was fully licensed with FL Board of Pharmacy, DEA, and 46 non-resident States within five months.• Generated $2M revenue per month, enrolling 5,000 + members, servicing their prescription needs. • Achieved exit strategy with acquisition by Sanare, LLC. within four months of launching operations.
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Executive Vice President, Clinical & Pharmacy OperationsExpress Scripts 2005 - 2009St. Louis, Mo, UsAcquired by Express Scripts in 2012, PolyMedica Corp (NASDAQ: PLMD,) doing business as Liberty Medical Supply, Inc. offered healthcare products and services and was the leading direct-to-consumer provider of diabetes testing supplies, prescriptions, telehealth demand management services and C-PAP equipment and supplies, serving over one million active patients and owned and operated call centers with more than 2,500 employees across the US. Medco Health Solutions acquired Liberty in 2007.Formed new corporate division responsible for all clinical and pharmacy operations and sales for Liberty across the U.S. Led over 1,000 associates nationwide with full responsibility for department performance and strategic direction, including revenue ($380M) and budgets ($30M) of clinical programs and education; direct-to-consumer sales and marketing; resource planning; implementation of new customer service and pharmacy systems; plan sponsor and patient satisfaction.• Achieved 40% CAGR, growing revenue by 900% representing 40% of company margin.• Increased overall call center and pharmacy efficiencies by 65% while decreasing variable costs 43% • Increased pharmacy patient lives managed by 170% through direct-to-consumer marketing campaigns and creation of new Preferred Pharmacy based programs sold to Health Plans.• Earned 93%-member retention (+18%) and 97%-member satisfaction (+20%) through creation of a Journey Mapping and Member Engagement strategy implemented via call center and customer communications channels.• Led 450 clinicians in 24x7 telehealth virtual call center, performing patient triage, education and data collection.• Developed, sold and implemented clinical programs and services: specialty pharmacy channel optimization, pharmacogenetic testing for warfarin and tamoxifen, HbA1c Testing and Education, ADA certified diabetes patient education program, medication compliance, at home insulin pump education and training. -
Senior National Account ExecutiveMedco Health Solutions Inc 2004 - 2005Medco Health Solutions is a Pharmacy Benefit Management Company serving the needs of over 50 million members with annual revenue of $52B.Formed new business unit with responsibility to develop products and services required to participate in the Medicare Modernization Act of 2003. Full responsibility for enterprise interactions with CMS: policy, enrollment and billing, claims, customer service, inquiries, grievances, client presentations, training and quality, systems maintenance, compliance, financial reporting, utilization reporting, and Office of Inspector General audits. Lead a team of more than thirty-five people across the organization. • Developed and managed strategic planning methodology and processes, tools, and timetables for the Medicare-approved Drug Discount Card program.• Developed and implemented new plan designs including: a drug formulary covering 209 therapeutic categories, Prior Authorization, Utilization Review, Coverage Limits, and Fraud & Abuse triggers.• Developed a retail pharmacy network with over 40,000 pharmacies and Medco mail order.• Negotiated, won, and installed State of New Jersey SPAP business with P&L over $100 million. -
Senior DirectorMedco Health Solutions Inc 2001 - 2004Formed new business unit with direct responsibility for product and service advancement of core customer service capabilities to customers. Led the development of a world-class customer service vision as a strategy to achieve long-term competitiveness, sustainability and profitable growth. • Implemented a new generation customer service system to 600 clients /18,000 users over 14 months.• Created barriers to exit for twenty major accounts representing drug spends of greater than $20 billion.• Achieved a 42% operational improvement within one year eliminating $1.2 million annual costs.
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Director, Health ManagementMedco Health Solutions Inc 1998 - 2001Led staff of forty-five responsible for overall management and development of strategic direction for seven health management programs: Diabetes, Allergic Rhinitis, Asthma, COPD, Menopause, Multiple Sclerosis, and Osteoporosis. Led collaborative effort with United Healthcare and BCBS LA to integrate pharmacy, medical, and laboratory claims substantiating value propositions of the programs.• Accountable for P&L greater than $300 million.• Developed retail, mail and physician clinical programs to drive adherence with Best Medical Practices: Clinical Consultation, Drug Utilization Review, Prior Authorization, Step Therapy, and Physician Profiling.• Drove over 4 million communications and over 1 million telephone consultations to educate physicians and increase patient compliance with medications.• Attained full NCQA accreditation for Diabetes and Asthma programs .• Established and maintained strategic alliances with and endorsements from the American Diabetes Association, National Multiple Sclerosis Society, Mothers of Asthmatics, National Osteoporosis Foundation, ITG/Schering, Wyeth-Ayerst, Innovative Health Solutions, Boheringer Ingelheim, Berlex, Biogen, and Teva-Marion to reinforce “best practice” protocols and sustain revenue streams.
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Committee MemberAmcp 1998 - 1999
Clayton Edwards Skills
Strategic Planning
Strategy
Managed Care
Leadership
Healthcare
Management
Business Development
Pharmacy Benefit Management
Cross Functional Team Leadership
Healthcare Industry
Process Improvement
Business Process
Medicare
Organizational Effectiveness
Team Building
Organizational Development
Project Management
Program Management
Pharmacy
Analysis
Analytics
Medicaid
Disease Management
Pharmaceutical Industry
Change Management
Hipaa
Operations Management
Business Process Improvement
Product Marketing
Data Analysis
Executive Management
Project Planning
Pharmacy Automation
Negotiation
Sales
Utilization Management
Mergers And Acquisitions
Due Diligence
Pharmacists
U.s. Health Insurance Portability And Accountability Act
Clayton Edwards Education Details
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Saint Joseph'S UniversityHealth Administration And Marketing -
Albany College Of Pharmacy And Health Sciences
Frequently Asked Questions about Clayton Edwards
What company does Clayton Edwards work for?
Clayton Edwards works for Ascellahealth
What is Clayton Edwards's role at the current company?
Clayton Edwards's current role is Senior Vice President.
What is Clayton Edwards's email address?
Clayton Edwards's email address is ab****@****ail.com
What is Clayton Edwards's direct phone number?
Clayton Edwards's direct phone number is +130146*****
What schools did Clayton Edwards attend?
Clayton Edwards attended Saint Joseph's University, Albany College Of Pharmacy And Health Sciences.
What skills is Clayton Edwards known for?
Clayton Edwards has skills like Strategic Planning, Strategy, Managed Care, Leadership, Healthcare, Management, Business Development, Pharmacy Benefit Management, Cross Functional Team Leadership, Healthcare Industry, Process Improvement, Business Process.
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