Marie O’Donnell

** ***** ****** ******, ***. F** Rockville Centre, NY 11570 516-***-**** ac3exi@r.postjobfree.com

Project Management/ Program Management/ Pharmacy Benefit Management

Professional Summary

Accomplished Project and Operational Management Professional, with over twenty years experience. Resourceful, detail-oriented, self-starter, with demonstrated capabilities, within project management, quality, pharmacy operations, compliance and regulatory audits and vendor management. Develops recommendations, implements solutions, and identifies key success measures.

Key strengths include:

Project/Program Management Pharmacy Operations Vendor Management Regulatory and Compliance Audit Oversight Process Development & Improvement Relationship Building

Professional Experience

CareConnect, East hills, NY 2015 - Present

Project Manager, Operations

Responsible for the strategic and operational oversight of health insurance projects, including organization, implementation, evaluation, defining project goals, objectives, target initiatives, timelines, budgets, and design of project plan.

Successfully closed the following projects within this role, from 2015 to present:

oOverseeing Specialty Drugs – worked with Pharmacy Department to bring Specialty and Non-Formulary drug final determinations process in house. Saved $ 7- 9 million, due to this project.

oHEDIS 2016 and 2017 Audits - achieved a 100% pass rate, for both years, noting all records were found to be in compliance with requirements. Recognition from Senior Leadership noted, due to success of this project, which allowed the Quality Department to implement new strategies.

oDepartment of Financial Services and Department of Health Audits – worked with head of internal audit, and key stakeholders, on high level regulatory projects, pursuant to a New York State Department of Financial Services examination of our organization, and similar audit, requested by the Department of Health.

oHR Road Map Roll-Out – key player, working with Human Resources on the successful roll-out of unlimited time off, new quarterly review process, leave policies, career succession planning and updates to our Customer Service Training Program.

oBusiness Continuity and Disaster Recovery Plan - collaborated with Senior Leadership to successfully roll-out a plan, which provided the ability to shift resources, and recover from external events, which may cause disruption, to operations.

oRight Fax – successfully interfaced with vendor DST, to incorporate fax over internet technology, into CareConnect’s business applications. Implementation was a priority initiative, to assist our Medical Management Team, in increasing process efficiencies.

High profile projects, in progress, for 2017/2018:

oHEDIS 2018 Audit - execution will begin in November, 2017.

oDepartment of Financial Services and Department of Health Audits – close out all audit findings, with key stakeholders,

oFIDA Wind Down Project

Village Care, New York, NY 2014 – 2015

Director of Operations, Certified Home Health Agency

Oversight, management and reporting, of all business and financial functions, within the CHHA.

Ensured timely billing, by overseeing and maintaining the timely signing of physician orders. Managed one direct report, within this role.

Visiting Nurse Service of NY, New York, NY 2013 - 2014

Manager, STARS Performance Oversight and Clinical Operations Support, VNSNY CHOICE Executive Office

Combined position, to manage project/program and operational responsibilities, within the Quality Department.

Successfully managed health plan initiatives, working with VNSNY CHOICE Senior Leadership on projects related to Prospective Assessments and STARS Performance Oversight.

Managed Prospective Assessment process and vendor relationships, working in collaboration with Medical and Quality Departments, in order to close Gaps in Care, and ensure compliance.

Provided Medicare STARS oversight, in order to monitor tasks and deadlines.

Key player supporting Pharmacy initiatives, involving Part D STARS

Prepared reports and updates for Quality Improvement Committee Meetings.

Designed, initiated, and oversaw, strategies and projects that foster the application of continuous quality improvement among Medicare products, in collaboration with Senior Leadership.

Managed one direct report, within this role.

Healthfirst, New York, NY 2010 - 2012

Pharmacy Manager, Pharmacy Services

Supported stakeholder management and request for proposal (RFP) selection process, to include timelines, presentations and project charter reviews, for 2013 PBM vendor Selection process.

Successfully managed Regulatory and Compliance Audits, to meet quality initiatives.

Led investigations and research, of Fraud, Waste and Abuse, with Special Investigations Unit and vendor Express- Scripts.

Managed Delegate Vendor Oversight Committee updates to Senior Management, on outcome of pharmacy audits, oversight of vendor and status of implementations in progress.

Emblem Health, New York, NY (Group Health, New York, NY) 1997 - 2010

Pharmacy Manager, Pharmacy Services

Collaborated with leadership on the successful transition from PBM Merck-Medco to Express-Scripts.

Developed and implemented, all day to day operational activities, surrounding claims adjudication, customer service and compliance, to support the administration of the Pharmacy Program.

Implemented metrics and created a dashboard, to track and trend, for Senior Management.

Managed three direct reports, within this role.

NYL Care Health Plans, New York, NY (New York Life Insurance Company) 1991 - 1997

Senior Product Development Associate

Managed the development of the Company’s Dental PPO Product, thru solicitation of dentists across the United States and reporting on network penetration.

Marketing Associate

Pro-actively managed leads and lists for agents, developing agent and field force training tools.

Education & Training

Molloy College

Bachelor of Arts in Business Management

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