⇨ Implemented pharmacy clinical criteria with platform migration preferencing changes supporting initiative that clinical criteria remained current & aligned with evolving preferences, facilitating a seamless transition.⇨ Collaborated with IT Developers & key stakeholders to create a Service Now Ticketing Request form & process for clinical pharmacy criteria implementation to ensure timely advancement of blueprinting recommendations & alignment of initiatives contributing to the delivery of… Show more ⇨ Implemented pharmacy clinical criteria with platform migration preferencing changes supporting initiative that clinical criteria remained current & aligned with evolving preferences, facilitating a seamless transition.⇨ Collaborated with IT Developers & key stakeholders to create a Service Now Ticketing Request form & process for clinical pharmacy criteria implementation to ensure timely advancement of blueprinting recommendations & alignment of initiatives contributing to the delivery of over $25 million in HBR initiatives.⇨ Maintained accuracy rate of over 99% of over 21,000 clinical pharmacy criteria implementations to an Internal SharePoint.⇨ Received 2022 Elite Performers Information Security Champion award for demonstrating an understanding of cybersecurity risks by successfully passing & reporting monthly simulated phishing exercises.⇨ Selected to represent Centene as a Fellow for Greater St. Louis, Inc's The Fellows Experience.⇨ Submitted Companywide 2022 SPARK All of US Research Program Partnership idea that reached the Crowd Validation level with a 4.1 out of 5 Star Rating.⇨ Captured workforce expense savings through successful implementation of automated processes resulting in reducing drug prior authorization review error fines, costs associated with appeals reviews & $35,000 annual outsourcing platform fees.⇨ Drove efforts to rebrand the company’s Marketplace Ambetter Health Plans Prior Authorization forms steering faster reviews & prompting adherence to contract requirements.⇨ Active member of employee Diversity, Equity & Inclusion groups including MOSAIC-Multicultural Network, I.N.S.P.I.R.E.-Women's Network, Ability-People with Disabilities & Caregivers Network, CENVET-Veterans & Military Families Network, & cPRIDE-LGBTQIA+ Network:♦ Active mentee of MOSAIC Mentorship Program♦ Active member of MOSAIC Networking Subcommittee♦ Active member of MOSAIC Career Development Subcommittee♦ Active member of I.N.S.P.I.R.E. Innovation Subcommittee Show less

⇨ Modified operational processes from up to 120 hours quarterly to up to 8 hours quarterly by implementing Authorization Criteria for 20+ Local Market Teams on SharePoint lists & prior authorization platforms.⇨ Cut down redundancies & accelerated the implementation process centralizing 3000+ documents within 2 software platforms to include SharePoint & claim authorization systems.⇨ Reduced review time by expertly leading a team of 5, responsible for creating & updating prior… Show more ⇨ Modified operational processes from up to 120 hours quarterly to up to 8 hours quarterly by implementing Authorization Criteria for 20+ Local Market Teams on SharePoint lists & prior authorization platforms.⇨ Cut down redundancies & accelerated the implementation process centralizing 3000+ documents within 2 software platforms to include SharePoint & claim authorization systems.⇨ Reduced review time by expertly leading a team of 5, responsible for creating & updating prior authorization forms for specialty drugs to assist the patients & providers’ requests.⇨ Improved project time from 60-90 days to 30 days by institutionalizing standard project management processes, creating a central repository, tracking updates, & ensuring quality on all PA forms. ⇨ Achieved accuracy rate of over 99% of over 20,000 clinical pharmacy criteria implementation to the Internal Pharmacy Criteria Repository SharePoint site.⇨ Received All 2021, 2020 Information Security Champion award for demonstrating an understanding of cybersecurity risks by successfully passing monthly simulated phishing exercises.⇨ Received the Centene Key Contributor Award for displaying high degree of personal commitment & excellent performance.⇨ Active member of employee Diversity, Equity & Inclusion groups including MOSAIC-Multicultural Network, I.N.S.P.I.R.E.-Women's Network, Ability-People with Disabilities & Caregivers Network, CENVET-Veterans & Military Families Network, & cPRIDE-LGBTQIA+ Network: ♦ Active member of I.N.S.P.I.R.E. Innovation Subcommittee⇨ Displayed exemplary leadership skills & dedication by expediting antiquated processes & implementing & pioneering policies for 20+ Local Market Teams on SharePoint lists & prior authorization platforms. Identifying resources, resolving issues, & mitigating risks through innovative & strategic methodologies Show less

⇨ Created & updated schedules, employee access, & work assignments consistently seeking means to improve provider, member, & third-party services.⇨ Created Medicare Part B & D initiative project & led team of 10 to ensure members’ benefits were appropriately coordinated & members received medication in a timely manner supporting desired cost-savings & positive clinical outcomes.⇨ Delegated & audited department calls, authorizations, member eligibility, & projects to ensure the accuracy… Show more ⇨ Created & updated schedules, employee access, & work assignments consistently seeking means to improve provider, member, & third-party services.⇨ Created Medicare Part B & D initiative project & led team of 10 to ensure members’ benefits were appropriately coordinated & members received medication in a timely manner supporting desired cost-savings & positive clinical outcomes.⇨ Delegated & audited department calls, authorizations, member eligibility, & projects to ensure the accuracy of benefits.⇨ Created standards of processes training, resource documents, & oversight, & mentorship for 30+ pharmacy technicians, Department Leads, & Department special teams.⇨ Monitored & maintained compliance requirements & provided accurate & timely feedback, including a comprehensive understanding of CMS Medicare & Medicaid regulations, appeals & grievances, Centers for Medicare & Medicaid Services (CMS) Complaints Tracking Module within Pharmacy, On Call pharmacy benefit issue reporting, & On-call emergency Pharmacy benefit resolution, among other vital responsibilities.⇨ Received the following awards for displaying high degree of personal commitment & excellent performance:♦ Centene (Envolve Pharmacy Solutions) SPARK Innovation Challenge Runner Up: 2018♦ Health Net March for Babies Team Captain: 2017⇨ Active member of employee Diversity, Equity & Inclusion groups including MOSAIC-Multicultural Network, I.N.S.P.I.R.E.-Women's Network, Ability-People with Disabilities & Caregivers Network, CENVET-Veterans & Military Families Network, & cPRIDE-LGBTQIA+ Network. Show less

⇨ Trained & oversaw new associates.⇨ Monitored & maintained daily department production & service levels.⇨ Successfully resolved escalated calls & processing issues.⇨ Conducted audits on incoming calls, CMS finance material, & various projects to ensure accuracy & compliance.⇨ Achieved a significant reduction in pharmacy drug override error rate, lowering it from 57% to less than 3 utilizing previously implemented pharmacy technician override training & audit processes. ⇨… Show more ⇨ Trained & oversaw new associates.⇨ Monitored & maintained daily department production & service levels.⇨ Successfully resolved escalated calls & processing issues.⇨ Conducted audits on incoming calls, CMS finance material, & various projects to ensure accuracy & compliance.⇨ Achieved a significant reduction in pharmacy drug override error rate, lowering it from 57% to less than 3 utilizing previously implemented pharmacy technician override training & audit processes. ⇨ Received Health Net SPOT award in 2016 for displaying high degree of personal commitment & excellent performance. Show less

⇨ Answered & resolved inbound calls from members, doctors, pharmacies, brokers, & other healthcare-affiliated individuals.⇨ Provided efficient & high-quality customer service.⇨ Made outbound calls to members, doctors, & pharmacies for CMS adherence & prior authorization.⇨ Engaged in additional special projects & member eligibility as required.⇨ Created & implemented a comprehensive override training process, conducting thorough audits, & retraining pharmacy technicians in their… Show more ⇨ Answered & resolved inbound calls from members, doctors, pharmacies, brokers, & other healthcare-affiliated individuals.⇨ Provided efficient & high-quality customer service.⇨ Made outbound calls to members, doctors, & pharmacies for CMS adherence & prior authorization.⇨ Engaged in additional special projects & member eligibility as required.⇨ Created & implemented a comprehensive override training process, conducting thorough audits, & retraining pharmacy technicians in their override inputs, ensuring a substantial improvement in accuracy & efficiency.⇨ Received the Health Net iROCK award in 2014 for displaying high degree of personal commitment & excellent performance. Show less

⇨ Division Leader Jun 2014 - Present⇨ District Leader May 2011 – Jun 2014⇨ Senior Representative May 2011 – May 2011⇨ Representative Mar 2011 – May 2011⇨ Developed individual, step-by-step action plans to prioritize client needs, guiding them from their current financial situation to their desired outcomes.⇨ Planned, coordinated, and presented office-recruiting events, group agent training sessions, and operated the PFD table/booth at exhibitions.⇨ Recruited, submitted… Show more ⇨ Division Leader Jun 2014 - Present⇨ District Leader May 2011 – Jun 2014⇨ Senior Representative May 2011 – May 2011⇨ Representative Mar 2011 – May 2011⇨ Developed individual, step-by-step action plans to prioritize client needs, guiding them from their current financial situation to their desired outcomes.⇨ Planned, coordinated, and presented office-recruiting events, group agent training sessions, and operated the PFD table/booth at exhibitions.⇨ Recruited, submitted applications, and trained new agents, providing both individual and group training through methods like lectures and job shadowing.⇨ Generated leads, scheduled appointments, and delivered custom, personalized financial plans while maintaining a strong focus on customer service.⇨ Annotated, field underwrote, and submitted various insurance applications, including life, long-term care, auto, home, and legal protection policies.⇨ Annotated, field underwrote, and submitted investment applications, such as variable annuity, fixed annuity, IRA, and Roth IRA accounts.⇨ Successfully maintained a high-quality business index by retaining clients for the long term, with a minimum of 18 months' engagement. Show less