Tom Castaneda Email and Phone Number
Senior clinical operations professional with demonstrated experience delivering consistent results, motivating teams, minimizing risk, and streamlining operations in the healthcare and insurance industries. Effective leader who utilizes business strategies to plan, along with management tools to drive change and create value leading to high customer service scores. Expertise in risk management and strategic operations with a consistent record of tackling strategic challenges, while establishing strong team cultures
Fidelity Investments
View- Website:
- fidelity.com
- Employees:
- 10
- Company email:
- Johrenk7@gmail.com
-
Senior Reimbursement Account ManagerFidelity Investments Apr 2023 - PresentBoston, Ma, Us -
Pbm Operational Site LeaderPharmpix Corp Sep 2021 - Jan 2023Irving, Texas, UsProvided day to day leadership of the Texas site operational teams, specific functional responsibilities, including Pharmacy Help Desk, Client Services, Benefits Management, and Clinical Call Center. • Responsible to ensure the professionalism and adherence to established KPI’s for all roles and functions in the office either directly, or in a matrix management role with the leader of the specific function.• Liaison with IT and HR appointed resource to ensure office is adhering to all established policies and guidelines. • Accountable for ensuring all PharmPix operational goals, objectives, and policies are met. -
Strategic Health Plan Clients – Operations ManagerCvs Health Sep 2020 - Mar 2021Woonsocket, Ri, UsManaged day to day work volume for (3) of the largest strategic clients TUFTs Health Plan (1 million lives) Molina Healthcare (3 million lives) and a new client Blue Shield California (2.3 million lives).• Ensured all pharmacy benefits for these clients were maintained in adjudication system.• Team’s quality was measured (based on contractual agreements) against the highest standards to ensured clients and members receive the highest level of satisfaction. -
Centene Clinical Configuration ManagerCvs Health Apr 2017 - Aug 2020Woonsocket, Ri, UsCentene is the largest Medicaid Managed Care Organization in the country and an extremely important Strategic Client. As the largest carrier on the Health Insurance Marketplace and a national leader in managed long-term services and support. By focusing on quality and leading my team through process improvement (Kaizen) methodology we ensured this critical client resigned with CVSHealth• Successfully Implemented 8 states + supported all MOBs for PDLs, SMART Edits• Lead the PC review committee, which has been recognized by our leadership as a very successful process. Process will continue to evolve going forward as the team gains experience with root cause analysis and creating corrective action plans. -
Health Plan Medd Configuration ManagerCvs Health Mar 2011 - Apr 2017Woonsocket, Ri, UsReviewed, tested, and implemented clients’ benefit drug plan setups into claims adjudication system and provided management support of over twenty-five (25) + employees across two locations – Irving and San Antonio. Formed new MedD team to code and QA cases for all MedD clients submitted thru SFDC.• If additional training was needed, report provided a full view of employee areas of concern or improvement.• Team was Recognized 27 times for exceeding expectations through-out the year by their peers and the Leadership Team. -
Front End Mail Operations ManagerPrime Therapeutics Feb 2009 - Mar 2011Eagan, Mn, Us -
Specialty Benefits Verification ManagerCvs Health Sep 2007 - Feb 2009Woonsocket, Ri, Us -
Specialty Benefits ManagerCvs Health Sep 2005 - Aug 2007Woonsocket, Ri, Us
Tom Castaneda Education Details
-
Southwestern Jr CollegeGeneral -
Andress High SchoolAccounting And Business/Management
Frequently Asked Questions about Tom Castaneda
What company does Tom Castaneda work for?
Tom Castaneda works for Fidelity Investments
What is Tom Castaneda's role at the current company?
Tom Castaneda's current role is Operations Manager with over 25 years of experience in PBM and Health Care Industries. Health Services Leader | Client Management | Client & Consumer Experience Strategy | Service Delivery Manager (Healthcare).
What schools did Tom Castaneda attend?
Tom Castaneda attended Southwestern Jr College, Andress High School.
Who are Tom Castaneda's colleagues?
Tom Castaneda's colleagues are Aniket Banerjee, Robert Coutu, Sean Flynn, Jakob Haslam, Nick Eisinger, Sujata Paramguru, Anwesha Acharya.
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