Responsible for formulary strategy and rebate competitiveness

Responsible for enriching the Medicare pharmacy portfolio offerings, go to market strategy, and CMS compliance and filing

Responsible for drug acquisition contracts and negotiations, oncology pathway and oncology analyticsLead business development and products Oversee the Oncology Advisory Board Committee

Vendor Relationship Owner (VRO)Manage the vendors for prescriber data, product/drug information data, Coordination of Benefit (COB) vendor, and E-Prescribing vendor. Act as a liaison between all business segments and the vendors. Responsible for support, testing, maintenance, and research on the data flowing from the vendor to OptumRx.Product/Program ManagementResponsible for implementing clients on E-prescribing program and upselling the E-prescribing product to clients. Supported implementation of the E-prior authorization program through the same vendor. Supported client custom reporting through E-prescribing. Responsible for implementing Coordination of Benefit (COB) Discovery program and expanding the product to clients. Collaborated with Optum Payment Integrity team to establish a process for Medical COB discoveries.Reporting and ClaimsManage all claims reporting requests outside of datawarehouse. Complete claim analysis for forecasting, trending, uncovering systematic issues or inappropriate benefit and formulary implementations. Analyze pharmacy, prescriber or member behavior through claims. Complete member impact report for inappropriate Part D claims rejections. Responsible for end to end implementation of All Payer Claims Database (APCD) reporting to the states. Function as OptumRx Business Segment Lead for the transition for ICD9 to ICD10. Act as Subject Matter Expert for RxClaim system. Resolve benefit set up issues in RxClaim systemRequest for Proposal (RFP)Manage all RFPs specifically for claims and benefit functionalitiesOther ResponsibilitiesInterface with Regulatory and Compliance to ensure Claims Administration is compliant to all state and federal guidance. Responsible for migrating a number of Point of Sale programs from UnitedHealth Care’s previous PBM, Medco, to OptumRx. Manage a small team of employees and responsible for yearly merit and ratings of employees

Automated transitional benefits for Medicare patients, managed and supported the E-Prescribing program, resolved daily claims inquiries, implemented and created a process to reconcile drug application data discrepancies for Part D GAP benefit phase, managed changes in the claims system during the sunset of FDB AWP, completed UAT for the claim system and programs utilizing claims data, performed formulary and benefit internal auditing utilizing claims data, created business logic for Part D reject review automated database, and acted as SME during CMS audit for claims.