Ruth Leonard Email & Phone Number

Newport Beach, California, United States

• Health Plan Client support regarding Pharmacy Benefit Manager oversight, leveraging each PBM’s services, tools, capabilities, and contractual obligations.• Clinical evaluation of formulary and utilization management activities; benchmarking for clients with assessment of insource vs outsource capabilities and options for health plans.• Assist clients in PBM contract review and renegotiation of contract terms.• Assist clients to create or revise policies and procedures related to client’s responsibility in the administration of the pharmacy benefits.• Assist clients in monthly monitoring and outcome reporting.• Lead consultant for PBM, Medical Drug Management and Medication Therapy Management RFP procurement activities.• Assist with Clinical and Financial Audits for SBG clients; prepare and present reports for the client/PBM.

• Health Plan Client support regarding Pharmacy Benefit Manager oversight, leveraging each PBM’s services, tools, capabilities, and contractual obligations.• Clinical evaluation of formulary and utilization management activities; benchmarking for clients with assessment of insource vs outsource capabilities and options for health plans.• Assist clients in PBM contract review and renegotiation of contract terms.• Assist clients to create or revise policies and procedures related to client’s responsibility in the administration of the pharmacy benefits.• Assist clients in monthly monitoring and outcome reporting.• Lead consultant for PBM, Medical Drug Management and Medication Therapy Management RFP procurement activities.• Assist with Clinical and Financial Audits for SBG clients; prepare and present reports for the client/PBM.

Boise, Idaho Area

• Oversight and coordination of all Quality Improvement activities involving pharmacy.• Active involvement with interdepartmental projects regarding STAR initiatives for the Medicare Advantage population, HEDIS and URAC projects.• Development, implementation and oversight of new cost savings projects.• Development of medication adherence reporting and interventions.• Development and coordination of individual state exchange formularies in our four states of operation.• Successful leader in cross functional teams within the health plan and pharmacy operations.• Expertise in pharmacy claims systems utilizing Medispan and FDB data.

Boise, Idaho

• Development and execution of all pharmacy outreach and education programs for including Medication Therapy Management programs for Medicare Part D members and commercial plans.• Oversight and coordination of clinical coding including formulary coding, DUR, Prior Authorization (PA), step edits, quantity limits, MADD edits, and DACON edits.• Experience with retail pharmacy claims processors (RxClaim, Prospective Health Systems & Argus), medical claims systems (Facets) and predictive modeling tools (Impact Pro), Case management tools (Clinical Care Advance).• Review of all clinical coding, including preferred medication list (formulary), PA, step edit, DACON, MADD, preventative lists for claims processor transition from Argus to PHS.