Jim Krocak Email & Phone Number

Minneapolis, MN, US

Minneapolis, Minnesota, United States

Guiding clients' from strategy to implementation that achieves operational excellence, an elevated the member experience, and yields financial savings in the areas of healthcare operations, pharmacy management, and supplemental benefits.

Minneapolis, Minnesota, United States

• Directed overall pharmacy policies and procedures to optimize operations, vendor oversight and regulatory compliance.Scaled 3 health plans to a common Pharmacy Benefit Manager (PBM) resulting in financial, FTE and.
• Saved $41M through the Request for Proposal (RFPs), implementation, and on-going management.
• Implemented 3 PBMs in 3 years, including key areas of data exchange, benefit operations, marketing, call center, CMS disclosures and prior PBM run-out.Instituted oversight of vendor billing, reporting, invoice.
• Identified over $525K in reimbursements due to PBM billing errors, unutilized services, and missed SLAs.
• Aligned PBM to state prompt pay rules to mitigate over $125K in delayed payments to pharmacies.Established vendor proposal, procurement, assessment and oversight program resulting in enhanced contracting and SLA.
• Reduced Medication Therapy Management and adherence vendor billing rates by 15%, reduced plan oversite by five FTEs and improved adherence star ratings. Established Annual Pharmacy Readiness program to ensure PBM.

Minneapolis, Minnesota, United States

Provided transitional Leadership to launch five new markets, ensured flawless ID card setup, validation of eligibility and claim file testing, and established post 1/1 command center control for benefit and call center operations. Optimized the development, review and print execution of ID cards for 1.2M members creating a repeatable program for future.

Greater Minneapolis-St. Paul Area

Establishing organizational management, foundational tools and oversight structure for population health management programs, utilization management, and vendor activities. Regular engagement with medical management vendors and developing assurances of compliance and performance.

Greater Minneapolis-St. Paul Area

Optum business development for UnitedHealthcare partners that delivered unmatched strategic value for products, member satisfaction, health outcomes and profitability. Specifically oversaw the strategic coordination for managed care services, disease management solutions, home health visits and audiology solutions.

Bloomington, MN

Provided overall management and strategic approach to the Government Programs and Medicare support teams. Led the development of the broader client communication strategy and the annual operational effectiveness of the Medicare Part D programs. Established team of teams for annual readiness activities that resulted in a transparent, accountable and.

Minnetonka, MN

Coordinated and developed Product strategies and process improvements with various regional colleagues. Brought to market initiatives by navigating the complex organizational environment and facilitating decision with the appropriate United resources. Actively developed business proposals to support strategy and managed the resulting implementation..

Minnetonka, MN

Coordinated Medicare Product strategies between segments within UnitedHealth Group, including OptumInsight, OptumHealth, and OptumRx. Initiated and led the effort for the strategic review of the Pharmaceutical bid and rebates which resulted in achieving the best rebates bid out from companies to UHC. These results helped shaped strategic decisions for.

Established the structure, process documentation, and metrics for measuring internal performance and compliance for Medicare Part D operations. Established rigor and repeatability in annual readiness activities through collaboration, consultation, and analytical partnerships throughout UnitedHealthcare and OptumRx. Developed accountability for ensuring.

Greater Minneapolis-St. Paul Area

Responsible for managing 12 financial operation consultants and their client engagements. Success was determined by leveraging best practices in project management, operational efficiencies and program governance. Partnered with various levels of client management including executive leaders to ensure transparency in workmanship, profitable solutions and.

Greater Minneapolis-St. Paul Area

Client responsibilities included project management, consultative services in areas of financial operations, internal controls, tax and audit. Within the corporate structure, regularly partnered internally with management for business development and staff development. Won the 2006 Financial Operations Consultant of the year as a result of high level of.