Mareesa Hedger Email & Phone Number

• Served as the primary resource for all clinical related specialty pharmacy initiatives for a select group of health plan clients.
• Collaborated with account executive and account manager on business plans that addressed the payer’s clinical program needs
• Facilitated utilization, specialty pipeline review, gene therapy forecasting, and other clinical discussions to meet client needs
• Analyzed data and worked with the health plan to formulate goals and action plans related to program enhancement, member care, drug trend management, and cost containment
• Developed, prepared, and presented clinical business strategy

St. Louis, MO

• Led account team support of large health plan client relationship and project implementation, including strategic home delivery initiatives and clinical cost of care programs.
• Recruited, built and trained team of account executives and clinical account executives.
• Contributed to organizational key initiative by partnering with internal teams to successfully implement small group alliance with high visibility to senior leadership.
• Consulted on clinical selections and strategic program enrollment for new business installation and supported creation of formulary publications and state regulatory filings.

• Oversaw clinical account team, clinical benefit set up, and specialty pharmacy and home delivery strategies for 7.9M Commercial and Health Insurance Exchanges (HIX) lives of large health plan client.
• Served as HIX clinical lead transitioning 100% of client business on time and as planned.
• Received significantly high employee engagement score while leading team of pharmacists through change management procedures.

St. Louis, MO

• Implemented and supported daily clinical operations of Health Insurance Exchange (HIX) business for large health plan client, including formulary, drug lists, utilization management rules, rebates. Serviced over 1M.
• Managed custom N-tier formularies including daily maintenance and implementation of client Pharmacy & Therapeutics committee decisions and annual changes to align with state benchmark requirements.
• Reduced time of non-formulary exception reviews through consulting and building 14 preferred alternative lists.
• Met 100% client performance guarantee turnaround times for custom utilization management rule implementation.
• Generated revenue by building and implementing 29 smart utilization management edits.
• Developed and maintained custom drug lists to support copay exception, channel management and benefit exclusion.

Saint Clairsville, OH

• Delivered safe and accurate patient healthcare through consultation, medication dispensing, and clinical care programs. Led all aspects of pharmacy operations in regard to inventory, personnel and security with an.
• Evaluated medication utilization to optimize patient outcomes.
• Assessed accuracy and appropriateness of medication prescribing.
• Assured compliance with legal requirements within the pharmacy.
• Trained, mentored and coached pharmacy interns and technicians.
• Educated patients on medications and assisted in selection of over-the-counter products.