JANELLE TORTORIELLO MACHYNIA

**** * ******* ** *** 129 • Colorado Springs, Colorado

ac42fh@r.postjobfree.com • 630-***-****

Healthcare Management

Sales / Client Focus / Goal Oriented

Flexibility / Project Supervision / Follow-Up

Energetic, results-producing pharmaceutical professional with experience dealing with all aspects of superior customer service. Success in managing multiple projects with competing priorities. Effectively collaborates with superiors, clients, providers and pharmacies to achieve project objectives. Maintains efficiency through organization and great attention to detail. Strong in both oral and written communication skills, along with interpersonal interactions. Proactive in building relationships. Operation and Management Strengths:

Excellent Written and Verbal

Communication Skills

Excellent Customer Service and

Conflict Resolution

Data and Operational Reporting

Organization and Efficiency

Maintaining Company Objectives

Researching Alternatives

Liaison Between Doctors and

Insurance Companies

Task Management and

Troubleshooting

PROFESSIONAL EXPERIENCE

Molina Healthcare (Oak Brook, IL)

Pharmacy Services Manager (2015-Current)

Managing, plans, directs, evaluates, and develops the entire department. Maintains staff by recruiting, selecting, and orienting employees; maintaining a safe, secure, and legal work environment; developing personal growth opportunities. Supervises the daily operations of the Pharmacy staff to assure prompt and appropriate processing of requests for non-formulary or prior authorization required drugs. Analyzes pharmacy utilization and cost. Oversees pharmacy benefit eligibility processes. Planning, implementing and evaluating pharmacy cost saving projects. Works with business analysis and IT in various enhancement projects. Assures that work schedules are kept and reported and that adequate staffing coverage is present at all times of operation. Reviews and approves requests for PTO and signs off employee work hours in KRONOS. Provides performance evaluations for the Technicians and helps identify and provide for training needs, in collaboration with the Director. Acts as a liaison to internal and external customers to ensure prompt resolution of identified issues. Communicates with practitioners and pharmacists. Assists the Director in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. Assures that needed supplies for department operation are present. Collaborates with and keeps the Director apprised of operational issues including staffing resources, program and system needs. Develops needed policies and procedures. Assures that processes are compliant with NCQA guidelines. Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies.

Molina Healthcare (Oak Brook, IL)

Pharmacy Services Supervisor (2013-2015)

Plans, directs, supervises and develops the entire department.

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JANELLE TORTORIELLO • Page 2

Supervises the Pharmacy Technicians who support the processes involved with the review of non- formulary or prior authorization drugs. Also participates in the daily work flow of the department. Responsible for assuring that activities and functions are in accordance with policies and procedures. Provide performance evaluations for Pharmacy Technicians and helps identity training needs in collaboration with Pharmacy Director. Acts as a liaison to internal and external customers to ensure prompt resolution of identified issues. Communicates with practitioners and pharmacists. Assists the Director in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. Assures that needed supplies for department operation are present. Collaborates with and keeps the Director apprised of operational issues including staffing resources, program and system needs. Develops needed policies and procedures. Assures that processes are compliant with NCQA guidelines. Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. Participates in the daily workload of the Department. Selected Contributions:

Assist in building the new Pharmacy Department from scratch.

Designated Pharmacy trainer for other departments.

Assist in corporate projects and coding setups in Pharmacy Systems. Catamaran, formally known as SXC Health Solutions (Lisle, IL) RxAUTH Clincal Operations Supervisor (2012-2013)

Plans, directs, supervises and develops the entire department. Assisting in the prior authorization management solution and offering flexibility and efficiency in automating the prior authorization process from end to end. Recognize and strategize operational improvements. Responsible for the day-to-day application of organizational policies and procedures. Effectively communicate with multiple departments and clients. Interviewing, hiring, and training associates; planning, assigning, and directing work; appraising performance; and other associate issues as they arise. Provide management functions and controls to ensure projects stay on course, on schedule and are completed by a strict deadline.

Prior Authorization Supervisor (2009-2012)

Plans, directs, supervises and develops the entire department. Establishing goals and implementing guideline required to present a highly competent clinical call center. Recognize and strategize operational improvements. Responsible for the day-to-day application of organizational policies and procedures. Effectively communicate with a variety of people, ranging from direct reports to clients to senior leadership, demonstrating a clear understanding of the clinical call center operations and client's needs, and the clinical call center's personnel's needs. Interviewing, hiring, and training associates; planning, assigning, and directing work; appraising performance; and other associate issues as they arise. Provide management functions and controls to ensure projects stay on course, on schedule and are completed in a timely, professional manner. This management role includes prioritization, strategic planning, personnel management, progress monitoring and the ability to work collaboratively with other departments.

Prior Authorization Specialist (2007-2009)

Oversees all aspects of operations for a national portfolio of clientele and PBMs. Input of prescription prior-authorization (PA) requests. In and out-bound calls from and to providers and members. Pharmacy technician/call center/health care delivery skills highly used. Third party medical/ prescription payment/claims adjudication skills. Rx Claim/Customer First system programs. Trouble- shooting submitted claims/calls/PA requests. Followed rules from the clients and criteria. Excellent attendance/time management skills. Resolved technical issues. Scanning/attachments. Create denial letters. Processed clinical & compound appeals. Work as a valued team member & independently. Selected Contributions:

Won Corporate Star Award from the State of Illinois in a national competition. JANELLE TORTORIELLO • Page 3

Won Perfect Attendance Award for outstanding attendance and punctuality record.

Received Great Asset Award.

Audited and implemented new policies and procedures for company.

Highly experienced in working with PBMs.

Dominick’s (Carol Stream, IL)

Pharmacy Technician (1999-2009)

Responsible for the disbursement of prescriptions in a retail setting and accommodating all patient needs. Processed Prescriptions. Billed/contacted insurance companies. Managed flu clinics. Provided customer service and handled special requests and orders. Worked the cash register. Helped with coverage at multiple locations. Helped opening and setting up new pharmacies. Inventory control (stocked shelves, pulled out-dated and expired products, inventory and credit returns, and ordering prescriptions, OTCs and special-request medications). Trouble-shoot any problems that may occur. Answer phones/take messages. Works well under pressure; multi-tasking. Knowledge of PDX, SMO, computer programs. Selected Contributions:

Team Lead for multiple pharmacies.

Became the “go-to” person on prescription matters.

Patients “preferred” pharmacy technician.

EDUCATION AND TRAINING

Bachelor of Science, Health Administration • UNIVERSITY OF PHOENIX, Phoenix, Arizona Associate Degree, Science • COLLEGE OF DUPAGE, Glen Ellyn, Illinois Associate Degree, Fine Arts • COLLEGE OF DUPAGE, Glen Ellyn, Illinois Professional Development

Pharmacy Technician License. Certified Pharmacy Technician. American Red Cross, Certified CPR

Technical Proficiencies

Microsoft Office (Word, Excel, PowerPoint & Outlook) • HIPAA- Compliance, training, security, policy, software, certification • Patient Privacy Acts • PHI: Protected Health Information • Comfortable and proficient with all office equipment • Typing 65-70 WPM • Internet

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