CMS Data Validation Auditor; URAC Pharmacy Data Validator; ACHC Certified Consultant for Pharmacy and DMEPOSProjects include:Audit health plans to ensure that CMS measure reporting requirements are met for Part C & D.Audit PBMs to ensure CMS reporting complianceValidate Specialty Pharmacies, Mail Service pharmacies and PBMs to ensure data submission compliance to URAC

Conduct non-financial auditing and consulting engagements with a focus on Medicare Data Validation and URAC Pharmacy Validation. Acted as a subject matter expert on pharmacy specific measures and lead the overall strategy to validate specific Medicare and URAC measures. Addition consultant engagements included RADV Audits; Medicare Independent Audit Validation; and Patient Assistant Programs.

Strategic Account Executive leads the account team and serves as the client’s single point of contact responsible for their overall satisfaction and service. To help clients achieve their financial, service, and operational objectives, responsible for managing the overall client relationship, providing strategic leadership, monitoring program performance, and maintaining regular client communication, including onsite quarterly meetings. Has the overall responsibility for client retention, service, and contributing to strategic planning in support of the client.

The primary contact for Medicare business having overall responsibility for operational and strategic Medicare initiatives. Works provide proactive Medicare client support in the areas of regulatory interpretation, yearly planning, benefit consultation, and clinical management. Assist with yearly Application and Sales support for assigned client base, which includes, but is not limited to presenting new Medicare products and services; assisting with RFP responses and sales meetings; and supporting the client's sales force where possible to ensure in-group growth of the client's total Medicare membership base.

Responsible for growing new and existing business within the CVS Caremark's Medicare Division. Working with both existing clients and new prospects in a consultative manner to educate clients and prospect on Health Care Reform and retiree prescription benefit options, include EGWP and RDS. Massachusetts Licensed Producer - Life, Accident and Health, reciprocating throughout the USA.

Responsibility for both clinical and non clinical product development with an emphasis on development, implementation, compliance and management of government programs. Primary focus on Medicare Part D programs, MAPD, SNP, PDP and RDS with additional support provided to the Medicaid products. Actively engaged in support of sales force as well as the Medicare Part D subject matter expert.

A member of a sales team offering utilization management and case management software solution products and report tools for regulatory compliance to large HMO's. Also responsible of the day-to-day service, renewal of existing, and addition product offerings. Deliver sales presentations and demonstrations to maximize sales performance.

The Client Support Manage leads a team of 8 to 10 mid-level staff members who support the client Services department. We are responsible for the development, implementation, and management of all Benefit Plan designs including formularies. We work with our sales team to produce Request for Proposals for new and existing business. The team develops and manages standard and ad-hoc reports for internal and external clients various cost saving products, quality assurance measures for the Group Sales Division.

DUTIES: Project Manager / Implementation Coordinator: Leader of the implementation team who coordinates new business conferences, mailings, and informational materials. Additional duties include establishing procedures for new business implementation, training incoming clients, preparing and presenting materials, reviewing changes in health care regulation for implementing clients, coordination of projects among various internal departments, and leading quality assurance projectsPharmacy Operations – October 1996 - August 1997CLINICAL PHARMACY TECHNICIANDUTIES: A member of the clinical staff that reviews medication requests from health care providers. Medications requests are reviewed based on guidelines, in order to help control the rising costs of health care. Developed procedures and forms in order to stream line various processes.

169th Military Police Company; Warren, Rhode IslandCOMPANY MEDICAL SPECIALIST – September 1990 to March 1996 & August 1996 to January 1998Responsible for the general health and safetyRETENTION NCO – July 1991 to March 1996Responsible for retaining soldiers upon end of enlistment, consulting soldiers about educational and career opportunities. Set up the New Soldier Orientation Program Rhode Island Military Academy, Narragansett, Rhode IslandOFFICER CANDIDATE - March 1996 to August 1996DISCHARGE: Honorable