Providing Regulated Markets subject matter expertise to enable client growth and retention goals, perform strategic market analysis, and support implementation of new product solutions.• Led cross-functional contract review of 25 Medicaid markets in support of the Centene PBM contract capture team• Created and currently maintain the Medicaid Market Risk Tracker Tool, facilitating rapid assessment of changing market dynamics to support regulatory compliance• Created and currently… Show more Providing Regulated Markets subject matter expertise to enable client growth and retention goals, perform strategic market analysis, and support implementation of new product solutions.• Led cross-functional contract review of 25 Medicaid markets in support of the Centene PBM contract capture team• Created and currently maintain the Medicaid Market Risk Tracker Tool, facilitating rapid assessment of changing market dynamics to support regulatory compliance• Created and currently maintain state-focused Pharmacy Program Watch List, monitoring changing state programs to support targeted sales efforts • Lead advisor/subject matter expert to Senator Geoff Gratwick, M.D. of Maine concerning Medicaid Prior Authorization functionality and areas for enhancement • Created Master Rebate Exclusion document, enabling ESI Medicaid Rebate Team to accurately administer Medicaid drug rebates by state• Lead point of contact for research related to Medicaid Fee for Service programs across the country, allowing senior leadership to effectively assess de novo growth opportunities Show less

Leveraged Regulated Markets expertise to serve as primary contact for all Special Projects in support of Account Management, Product Development, and Implementation teams.• Developed and managed intake of all issue resolution requests for Regulatory changes and new product development• Provided daily oversight and leadership to the Encounters Team• Created and led training development activities for Medicaid Liaisons, establishing the enterprise support model for all Medicaid… Show more Leveraged Regulated Markets expertise to serve as primary contact for all Special Projects in support of Account Management, Product Development, and Implementation teams.• Developed and managed intake of all issue resolution requests for Regulatory changes and new product development• Provided daily oversight and leadership to the Encounters Team• Created and led training development activities for Medicaid Liaisons, establishing the enterprise support model for all Medicaid clients• Led assessment of 2016 CMS Medicaid Managed Care Rule, collaborating with internal partners across the organization to ensure compliant implementation of requirements• Led and completed initiative to generate and automate inter-plan PA reports for three Medicaid clients• Developed, implemented and managed internal and client-facing Medicaid thought leadership collateral• Created Opioid state requirement tracker• Created state mandatory formulary tracker• Led update of Medicaid Client Handbook, including gathering updates from SMEs, proofreading information and finalizing document• Developed, initiated and facilitated weekly Medicaid Legislation Discussion Forum, providing Medicaid Liaisons with roundtable to review upcoming legislation impacting their clients Show less

Provided daily oversight and account management of all PBM operations for SCAN Health Plan.• Solely responsible, year over year, for AMS representation on Medicare projects related to EOB, Annual Benefits and Home Delivery• Attendance at various levels of requirement meetings with staff from across the company• Responsible for day to day operations in the lead account manager role for SCAN Health Plan• Responsible for collaboration with and leading of two additional account… Show more Provided daily oversight and account management of all PBM operations for SCAN Health Plan.• Solely responsible, year over year, for AMS representation on Medicare projects related to EOB, Annual Benefits and Home Delivery• Attendance at various levels of requirement meetings with staff from across the company• Responsible for day to day operations in the lead account manager role for SCAN Health Plan• Responsible for collaboration with and leading of two additional account managers assigned to SCAN Health Plan supporting Medicaid and Medicare lines of business• Responsible for drafting, editing, and content approvals for Internal/External Medicaid alerts• Sole AMS representation for:o Florida Restricted Pharmacy Network (Medicaid ID)o New York Specialty Network Regulationo New York RX Serial # Requiremento New York Encounter File Enhancementso New York Emergency Vaccine Mandateo New York Encounter Quantity Error Correction• AMS Medicaid SME representation for global initiatives:o Remove of auto-fill in Medicaid LOB in F14o MMP Implementationo Pharmacy Returned Check Processo Pennsylvania Anti-Mail Guidance Initiativeo Medicaid client post-term activity agreement Show less

Provided daily oversight and account management of all PBM operations for SCAN Health Plan.• Solely responsible, year over year, for AMS representation on Medicare projects related to EOB, Annual Benefits and Home Delivery• Led implementation of CMS-required EOB updates• Led EOB template/requirements review with Medco team for alignment for merger• Attendance at various levels of requirement meetings with staff from across the company• Responsible for day to day… Show more Provided daily oversight and account management of all PBM operations for SCAN Health Plan.• Solely responsible, year over year, for AMS representation on Medicare projects related to EOB, Annual Benefits and Home Delivery• Led implementation of CMS-required EOB updates• Led EOB template/requirements review with Medco team for alignment for merger• Attendance at various levels of requirement meetings with staff from across the company• Responsible for day to day operations in the account manager role for SCAN Health Plan• Led internal system enhancement projects to ensure CMS compliance with COB set up and eligibility feed for all lines of business• Developed and implemented:o Monthly Indemnity Disenrollment Reporto Non-Formulary alternative process to expedite NF delays at home delivery• Researched and created:o FTP process document for account managers to share files with their clientso Manual claims denial letter process document for account managerso CMS Complaint Tracking Module process document for account managerso Internal/External Report Trackero Communication templates to distribute key information to account teamso Communication templates for account teams to distribute key information to their clients Show less