Trish Short Email & Phone Number

Tampa/St. Petersburg, Florida Area

• Spearheaded focus on integration of Health Choice AZ, Health Choice FL and Humana Plan delivery systems and solutions for Florida launch of MMA program
• Implemented oversight of pharmacy department adherence and process improvements for regulatory, compliance and contractual obligations to CMS and AHCA for 100K Medicaid enrollees
• Performed as clinical pharmacy liaison for pharmacy benefit operation and medical management operations
• Streamlined physician consultation and education on cost-effective prescribing as well as providing Best Practice programs based on prescription and medical claims data
• Strategized potential business and/or operational opportunities by conducting and guiding work on complex projects and programs
• Administered and monitored Florida specific Utilization Management as well as Quality Improvement for medical services delivered by contracted healthcare providers

Tampa/St. Petersburg, Florida Area

• Executed clinical review of managed care services for Specialty medications and Oncology utilizing NCQA and URAC standards
• Strategic analysis of potential business and/or operational opportunities by conducting and guiding work on complex projects and programs across all lines of business; oversight of staff of 32 prior authorization.
• Designed & implemented medical benefit management program with $5.7 million savings to plan
• Integrated the continuous evaluation of Utilization Management as well as Quality Improvement for medical services delivered by contracted healthcare providers; Curtailed fraud, waste and abuse (FWA) by monitoring and.

Tampa/St. Petersburg, Florida Area

• Analyzed Medicare funding risk buckets; actively managed Medicare Part B and Part D medication expenses for >50% of Humana’s HMO
• Leveraged and maintained average Part D expenses at $14 PMPM below marketplace
• Incorporated Formulary building, Pharmacy and Therapeutics presentations, and Quality Medical Outcomes for risk providers and MSOs
• Innovative strategic planning and presentations to physician groups promoting ‘Best Practices’ to enhance cost-effective quality medical/pharmaceutical care
• Consultant in development of NCQA Disease Management Program, MRA coding initiative and increasing scores for HEDIS measures
• Generated provider contract purchasing programs for specialty drug products

Tampa/St. Petersburg, Florida Area

• Supervising pharmacist for staff model pharmacy providing oral medications, injectable and DME products; yearly gross sales exceeding $1.2 million
• Implemented programs to provide consistent use of appropriate medications from Humana preferred drug list for Medicare AND commercial plan members
• Maintained medical benefit costs for Commercial insurance members including Hillsborough County School Board and City of Tampa employees

Bachelor Of Science - Bs

Mtm National Certificate

Consultant Pharmacist

Bachelor Of Science - Bs