Waneshia Norman Email & Phone Number

Murrieta, CA, US

United States

California, United States

• Lead State Regulatory Project Implementation for the Medicaid Preferred Drug List (PDL), including but not limited to defining project scope, creating and maintaining project plans, facilitating weekly internal and.
• Participated in the implementation of the Regulatory Ordering or Referring Physician (ORP) requirements and post implementation claims monitoring activities
• Prepared Power Point presentation and participated in on-site quarterly business financial review
• Participated in the Implementation of a Managed Care Organization (MCO) start up Medicare Plan
• Maintain PBM documentation including, plan maintenance of business documentation, testing scenarios, protocols, communications check list, etc.
• Seek opportunities for process improvements and develop best practices to create increased consistency and accuracy

California, United States

• Manage day to day operations for Health Plans Medicaid, Commercial, and Exchange business
• Interface with assigned clients
• Responsible for monitoring specific Performance Guarantees to meet contractual obligations
• Ensure pharmacy product changes occur with minimal disruption
• Responsible for ensuring state encounter files are produced in a timely manner and researching all resulting errors
• Manage client reporting requests

Telecommute

• Interface with new, existing, and potential clients
• Work with peers in other business units to research and solve identified problems
• Work with IT to define business and system requirements to address complex business needs
• Coordinate development, implementation, and compliance of new, renewing, and de-implementing clients
• Insure pharmacy product changes occur with minimal disruption
• Project manage small to medium projects

West Hills, California

• Perform analysis of benefit summaries supplied for potential, new, and existing clients
• Create performance, cost, and trend reports
• Coordinate development, implementation, and compliance of new, renewing, and de-implementing clients
• Oversee benefit set up process for National Accounts
• Insure pharmacy product changes occur with minimal disruption
• Work with peers in other business units to research and solve identified problems

West Hills, California

• Perform analysis, investigate, and review of enrollee and provider grievance and appeal claims for commercial, state sponsored, and Medicare Part D external client business.
• Gather and prepare documentation for physicians, pharmacists, nurses, independent review entities, hearings, and audits.
• Perform research duties and collaborate with customer service, prior authorization, physician staff, pharmacies, and other inner and outer entities to ensure each case is handled accurately and appropriately.
• Evaluate case files and provide administrative exceptions within prescribed guidelines.
• Provide training and guidance to clerks and grievance and appeals associates I & II.
• Generate written correspondence to enrollee’s, providers, and regulatory agencies.

West Hills, California

• Analyze, review, and process enrollee and provider grievance and appeal claims for external client business.
• Gather and prepare documentation for pharmacists and physician reviewers.
• Perform research duties and communicate with customer service, prior authorization, physician staff, pharmacies, and other inner and outer entities to ensure appropriate resolution to each case.
• Generate written correspondence to enrollee’s, providers, and regulatory agencies.
• Create monthly summary reports using an excel spreadsheet.

West Hills, California

• Analyze and review prior authorization requests for internal and external business clients.
• Served as the initial main point of contact for providers and pharmacies.
• Used computerized tracking systems for tracking, information gathering, and troubleshooting.
• Assisted the clinical specialist’s with call outs to provider offices to gather information.

Los Angeles, California

• Processed Tars, prior authorizations, presumptive eligibility (PE) forms, and prescriptions.
• Generated billing summary for the pharmacy
• Filled prescription drugs
• Heavy phone communication with worker’s compensation, social worker’s, providers, and insurance companies