1. What is your current job title and can you describe your position?
I am currently the Pharmacy Director, Payment Integrity, Specialty Pharmacy for Optum Insight, a subsidiary of the Optum family. I own and am responsible for our claims edit suite that focuses on medical benefit claim submissions for high-cost specialty medications.
2. How did you get to your current role? (Describe your path through pharmacy)
I started my managed care career over a decade ago as a prior authorization pharmacist. I subsequently moved into higher level roles developing policies for UM review, engaging with vendors to bolster our bottom line, and eventually moved into leadership roles within the behavioral health space and then as a pharmacy director for a local health plan here in Buffalo, NY before taking on my current role with Optum.
3. What is the day-to-day like? (Hours, weekends, travel, work nights, etc.)
I work remotely M-F, spending my work hours developing new content for our claims edit suite and also speaking to prospective clients that are interested in leveraging our edits. I also spend significant time ensuring our existing edits are clinically sound and also support other payment integrity initiatives as a subject matter expert within the medical specialty space.
4. Is further training required? (Residency, fellowship, previous work experience, etc.)
My current role certainly requires significant experience in the managed care space. I personally am not residency trained, but have been fortunate to excel in this realm due to a hybrid of clinical expertise as well as a keen ability to communicate to all levels of leadership.
5. How is work/life balance?
Work/life balance is extremely important to me and this role is perfectly equipped to allow that. Working remotely allows for a certain level of flexibility and my leadership team is very conscientious of ensuring there is a balance to mitigate burnout.
6. What is the long-term growth potential?
Growth potential is high. As we gear up for 2023, we are on a trajectory to likely hire additional support staff to continue the growth of this novel product.
7. What would be the very FIRST step you would suggest for someone looking to pursue a similar role?
Equip yourself with as much knowledge as possible regarding PBMs, managed care, formulary development, and pipeline release of applicable drugs.
8. What advice would you give to a pharmacist or student looking to pursue a similar career?
Similar to the above. Get your foot in the door and take any role you can within the managed care space. Be passionate about the realm of global impact and not just wanting to get out of the more traditional pharmacist roles.
9. What resources would you recommend to others interested in your position?
Keep abreast of the landscape in managed care. Consume as much information as you can to make yourself a desirable candidate. And lastly, always be yourself; let your personality shine through as this will be evident to employers.