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• Innovated methods for cross-functionality of teams for comprehensive assessment of care management and available alternative services for transition of care (TOC), acute case management, dual-eligible beneficiaries and complex needs populations

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 technicians • 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 reviewing Prior Authorization requests against Medically Likely Edits

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