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 lives across 14 states.• 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.• Identified and invoiced additional client rebate opportunities by collaborating with Pharma invoicing and contracting teams and assessing formulary placement, utilization management edits, and clinical review criteria.• Supported clinical benefit changes required by state mandates and Affordable Care Act to maintain regulatory compliance.• Completed benefit set up validations resulting in closure of Department of Defense corrective action plan.• Mentored and trained new teammates on HIX business and clinical processes.

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 emphasis on customer relations.• 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.• Administered vaccinations to decrease cases of influenza, pneumonia and shingles.