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 operational savings.• 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 management, prompt pay and service level agreements (SLAs).• 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 management.• 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 preparedness, adherence to CMS pre-delegation requirements, promoting enterprise alignment and delivering a best-in-class member experience. • Repeatable program and templates were leveraged by other departments; acknowledged as the standard for the organization. As part of taking the company public, established the Sarbanes-Oxley controls, testing, risk-mitigation and audit. Developed call center governance that introduced quality audits, enabled bilingual support, standardized plan reporting and that right-sized staffing levels.Chaired monthly pharmacy performance forums to leadership and teams to elevate visibility, train and improve cross-functional strategy.Emboldened a cross-functional Marketing strategy resulting in improved member action for plan year changes, benefit utilization and issue resolution.

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 plan years.Established the Enterprise 1/1 Command Center to monitor for negative operational trends, coordinate immediate issue remediation, and ensure a positive member experience by identifying over 120 issues and remediation plans.

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 repeatable business processes in order to meet compliance standards.

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. Specifically managed pilot programs to various UHC Medicare Markets for testing and proof of concept.

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 future plan year formulary and bid development and created an annual, repeatable process for coordinating rebates with Big Pharma.

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 changes to the various formularies were completed in an efficient, timely and complete manner.

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 deliverables were within budgetary requirements. Regularly ensured staff was professional and effective in their roles through continuous improvement initiatives, 360 degree review of work plans and conducting presentation training and feedback sessions. Genuinely maintained a "client-first" mentality to ensure deliverables exceeding expectations when completed.

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 client satisfaction and feedback. Extensive experiences in Sarbanes-Oxley, risk and mitigation processes, workflow and policy development, enterprise risk assessments, and report creation. Provided regular training of solutions handed off to clients and initiated follow-up and post-delivery service.