Deborah Hanselman Email & Phone Number

Petaluma, Ca, Us

Petaluma, Ca, Us

New York, New York, United States

Provide direction regarding new and existing legal requirements in the Pharmacy Benefit Manager space.

United States

Responsible for utilization review implementation for 32 states consisting of Implementing tracking for new and updated legislative requirements, gathering documents to support utilization review filings, and updating letters for compliance with legislation.• Led a team of Regulatory Adherence Consultants including training and career path development.• Served as primary contact for Utilization Review questions and activities including reviewing all state bulletins for utilization review and appeals impact, meeting with operations as needed to answer questions, hosting bi-weekly legislative implementation meeting, providing notes from weekly legislative call including summary analysis and direction for next steps, and reviewing previously completed research for continuing accuracy.• Managed end to end process for utilization review and appeals activities for the CA Department of Managed Care audits.• Supported commercial Exchange business with research for assigned states.• Reviewed and provided commentary for proposed legislation impacting utilization review and management.• Served as point of contact for special projects consisting of affordability initiatives, health literacy letter updates, and escalated issue inquiries.

San Francisco

Led breach incident response activities.• Provided guidance and training to operational areas regarding privacy responsibilities.• Investigated data breach incidents.• Analyzed, summarized and communicated new and proposed privacy legislation and regulation.• Reviewed and negotiated Business Associate Agreements with vendors.

Irvine, Ca

• Led team of Regulatory Affairs Managers to implement state regulatory requirements applicable to the pharmacy benefit manager and prescription mail service industries.• Directed regulatory efforts to onboard major new client to double membership administered by OptumRx.• Counseled business partners of all levels regarding interpretation of state and federal requirements.• Advocated to regulatory agencies as needed to maximize the opportunity to influence guidance and to reduce organizational burdens.• Analyzed, summarized, and coordinated compliance with Affordable Care Act topics impacting pharmacy benefit manager including interaction with ERISA and individual state requirements.• Prepared, submitted and negotiated approval of complex documents for utilization review license approval.• Analyzed and responded to Centers for Medicare and Medicaid concerns with respect to regulatory impact on Medicare products.• Facilitated implementation and continuance compliance with Medicare Part D operational issues through proactive problem solving.• Advocated to Centers for Medicare and Medicaid and other regulatory agencies as needed to maximize the opportunity to influence guidance and to reduce organizational burdens.• Managed geographically diverse staff including training, workflow, corrective counseling and career path planning.• Analyzed and coordinated compliance with Medicare and other federal regulations including ERISA, HIPAA privacy and Medicare Part D.

Irvine, Ca

• Analyzed, summarized, and coordinated compliance with commercial health insurance laws and regulations including interaction with ERISA and individual state requirements.• Subject matter expert in managed care legislation including utilization review, network adequacy and timely payment of claims.• Drafted comments to proposed legislation to lessen impact to operations.

United States

• Drafted pleadings in the areas of construction liability and family law• Counseled parties and mediated agreements in family law.

Juris Doctor, Law

Bachelor Of Science (Bs), Financial Management