firstname.lastname@example.org Hackettstown, New Jersey 07840 973-***-****
Accomplished professional with extensive management experience. Acknowledged for the ability to manage complex operations, formulate effective strategies, lead large projects, control costs, optimize operational efficiencies and exceed service and quality goals. Established leader who motivates and inspires both small teams and large groups of diverse personnel in a highly regulated and demanding client environment.
Project Management Customer Solutions Cross Functional Team Leadership Analytical Problem-Solving Medicare Part D Process Improvement
Magellan Health, Scottsdale, AZ (Remote) March 2018 – present
Director, Project/Program Manager
Key role in planning, directing and measuring the overall activities of large-scale, cross department projects. Work with executive management team on priority initiatives designed to improve operations and meet key customer deliverables as well as provide project management planning, execution and reporting to project teams, working closely with executive and leadership teams.
Report project status and apprise management of issues requiring resolution to maintain progress
Facilitate and lead internal functional and departmental project meetings as needed
Develop an appropriate detailed project plan and charter
Direct and coordinate project resources and personnel with single point of accountability
Meet with business process owners/staff to identify the project goals, objectives, critical success factors and measures
Develop and report key metrics related to project expenses and forecasted benefits
CVS/Caremark, Irving TX (Remote) March 2016 – February 2018
Pharmacy Benefit Management Services
Manager of Client Implementations
Responsible for managing the resolution and status of routine to complex client requests through effective and timely communication ensuring clients expectations. Demonstrate a high level of quality and client satisfaction through the execution of accuracy, responsiveness, and reliability.
Manage the overall implementation process for each assigned client for new business as well as support major changes to existing clients based on platform procedures
Track the progress of implementation using a project plan, conduct weekly update calls, and create and maintain an action log until tasks complete
Partner with sales and operations to support opportunities for new/existing client assignments, including transitioning the client to the Account Team for the on-going relationship with the client
Collaborate with internal partners to deliver customer requirements with timely and accurate documentation using management reporting tools
Responsible for working the incumbent vendors, consultants, and third-party administrations documenting and communicating key changes as required
Identify process improvement opportunities providing proactive, strategic solutions
Lead and complete special projects as assigned
EXPRESS SCRIPTS (formerly Medco Health Solutions), Franklin Lakes, NJ 1993 – 2015
Pharmacy Benefit Management Services
Senior Manager, Retail Network Strategies (2012 – January 2015)
Executed primary point of contact responsibilities for clients, guiding clients through retail pharmacy market dynamics, opportunities to reduce prescription drug costs via narrow and/or performance-based retail pharmacy networks. Subject matter expert for CMS network regulatory requirements and retail pharmacy processing variations that effect client performance goals.
Negotiated contract rates, terms and language for large retail chains, franchises and independent pharmacies in alignment with client network requirements. The network builds commitments were successfully compliant to go live dates resulting in high client satisfaction.
Product lead for network compliance to Centers of Medicare and Medicaid Services “Any Willing Provider” regulations. Evaluated pharmacy networks compliance on a state by state basis ensuring fulfillment of client expectation.
Formulated solution to prescription discount card processing that captured missing claims. Performed opportunity analyses, documented business requirements, and participated in/led cross functional discussions to increase CMS Star ratings for PDPs.
Managed in-depth Project Plan resulting in successful implementation of client network system requirements for adjudication platform.
Senior Manager, Retail Pharmacy Support (2003 – 2012)
Managed team of senior analysts, who resolved retail pharmacy disputes for over 65,000 pharmacies. Motivated, coached and directed the team to deliver cost efficient issue solutions that complied with company requirements. Utilized exceptional leadership skills to facilitate adherence to department’s financial and industry relationship building goals.
Led team of pharmacy-facing professionals; performed high-level relationship management functions with key providers and clients including adjudication adherence processes, policy requirements and issue resolution. Resulting in an annual cost reduction of $800,000.
Executed retail pharmacy Fraud Waste and Abuse oversight, decreased over-all client drug spend cost by
$420,000 and improved client Star ratings.
Implemented IT product solutions for Maximum Allowable Cost cases resulting in turn-around time reduction from 30 days to 2 days, operational savings of $370,000, in depth reporting functionality and analysis of market trends in real time.
Standardized Pharmacy remittance statements from paper mailings to 835 electronic file transfers in compliance with NCPDP standards, resulting in a $600,000 cost savings.
Directed third party vendor for all retail pharmacy out bound calling campaigns. Created the campaign SOP, trained participants and mentored the supervisor, established project goals and objectives. Created and presented management reports based on call data statistics.
Manager, Pharmacy Services Call Center (1998 – 2003)
Managed staff of 18 supervisors in a call center with 270 call servicing representatives. Executed strategic initiatives of cross-functional staff and developed key alliances to capture and enhance overall service, quality, productivity, business client satisfaction and bottom-line financial performance.
Developed creative solutions to service high call volume spikes by building temporary call center at corporate site. Effectively reduced operational staffing costs by $220,000.
Directed the first work at home program for call taking representatives. Worked cross functionally with regulatory, legal, systems, finance and training departments to meet project requirements. Resulted in $700,000 cost savings, improved quality service level from 93% KPI to 96% KPI.
Established a dedicated team of call handling representatives that worked directly with systems developers to identify systems platform enhancements that was rolled out to all call handling representatives. Resulted in a handle time reduction of 5 seconds with a total cost savings of $600,000
Bachelor of Arts, International Business/Minor, Finance, RAMAPO UNIVERSITY, Mahwah, NJ 07430
MS Excel MS Access MS Power Point MS Visio MS Project MS Word MS Outlook QuickBooks POS (Point of Sale Adjudication Platform) Remedy LMS (Learning Management Systems) SharePoint
Six Sigma Black Belt Trained PEGA Platform