Supports all account management activities for a large health plan including client contract, scorecards, and guarantees for Commercial and Medicare lines of businessDevelops and executes on joint strategic business opportunities through collaboration with internal partners and vendorsProvides clinical, regulatory, and operational consultation on internal and external initiativesProvides clients with consultation on new programs, products and benefitsCoordinates the implementation of new product adoptions, annual bid activities, and plan expansionsLeads and mentors a team of 3 Health Plan Account Managers across 2 clients and 3 lines of businessProvides exceptional client service and reaching the highest client satisfaction scores in Health Plan Markets

Provided business ownership of system enhancements and product launchesManaged workstream for new Medicare and Medicaid client implementationsEnsured compliance with federal/state regulations and claim adjudication standardsProvided cross-functional leadership in clinical, formulary, compliance, and IT workgroupsDeveloped and implemented departmental policies and proceduresIdentified and executed on continuous improvement initiatives to streamline processes and improve quality of Formulary and Benefit Operations workstreamsProvided business ownership and oversight of annual CMS Call Letter requirements, including: Hospice, ESRD, BvD, TIRF drugs, and concurrent DURProvided consultation and recommendations to clients and clinical staff regarding drug coverage, benefit design opportunities, and regulatory requirementsSupported quality assurance, clinical research, and analytical activities as related to benefit plansParticipated in client meetings, CMS audits, and internal project meetings as a benefit design SME to ensure relevant information is documented, shared, and addressedIdentified and implemented improvements to existing business processes

Built and managed a knowledgeable and experienced team of Medicare and Medicaid Benefit Operations PharmacistsServed as escalation point for all client-related issues and requests unable to be supported by individual contributorsDefined, built, and maintained benefit design within the claims adjudication system related to formulary lists, clinical programs, regulatory requirements and client specificationsImplemented adjudication system enhancements, policies, and procedures in support of client benefit design and state/federal regulationsCollaborated with internal departments for cross-functional support of new product offerings, system functionality and client implementationsEstablished, implemented, and maintained Government Programs compliance programs, policies, and procedures as related to benefit plan adjudicationCollaborated with peers for cross-functional support of new product development and client implementationsMonitored and reviewed department performance to identify process opportunities and team members in need of coaching and development

Assists in accuracy and maintenance Commercial & Medicare Part D formularies.Manages and communicates updates to the drug databases as a result of weekly drug file changes, P&T actions, Administrative Actions, other adhoc client requests.Develops and reviews medication guides and medication update pages used to create printed and electronic formulary products.Supports P&T Committee processes by providing accurate drug status information for each client.Serves as an internal resource for questions about Prime and client formularies and Medi-Span product file information.

Developed patient relationships by providing pharmaceutical care & counseling services.Served as patient advocate when interacting with other healthcare practitioners.Supervised pharmacy staff in processing and filling of approximately 2500 prescriptions per week.Trained new staff members on pharmacy operations and company best practices.Built and maintained partnerships with other executives within the store.Served as temporary pharmacist-in-charge.

Analyzed business needs and recommended improvements to processes and applications as required.Created supporting materials for communications such as lunch and learn sessions, scope documents, client presentations, etc.Anticipated issues proactively and escalated to management as appropriate.Gathered requirements, analyzed, developed, and tested production builds/enhancements.Collaborated with the release teams to understand future requirements and gave design, development, and testing guidance.Ensured both client and Accenture standards and best practices are followed on the team and within own area of work.