Jamie Duggins
Project Manager, PMP
Gresham,OR
Summary
Resourceful Project Manager with over 12 years of expertise in Retail and Long-Term Care Pharmacy and Pharmacy Insurance. Recognized consistently for performance excellence and contributions to success in the Pharmacy industry. Applying a creative and analytical approach to operations for continuous process improvement. Skilled at identifying or anticipating problems and providing solutions. Enjoys helping teams excel through mentoring, training, and empowerment. Knowledgeable in Pharmacy Operations, NCQA/Pharmacy Compliance, Formulary and Benefit Management, and more.
Overview
12
12
years of professional experience
2
2
Certificates
Certification
Project Management Professional (PMP 3195444)
Skills
Project planning and development
Work History
Project Manager
Cambia Health
08.2021 - Current
- Manage projects through initiating, planning, executing, controlling, and closing phases
- Scheduled and facilitated meetings between project stakeholders to discuss deliverables, schedules and conflicts
- Current projects being managed include:
Stars Measure Improvement/Pilot Program with large multi-vendor partnership/coordination
CMS Data Validation including PBM data requirements gathering
New Oregon House Bill Compliance Implementation working with Legal, Compliance, Analytics, Pharmacy Services and PBM teams
Creating SharePoint site for tracking of new OR, ID, WA and TX regulatory requirement tracking
Pharmacy Operations Quality Coordinator
Moda Health
04.2015 - 08.2021
- Managed pharmacy documents (E.g. PDLs and Utilization Management Information) and maintained changes and updates
- Performed Prior Authorization and Clinical Pharmacists Inter-rater Reliability audits, evaluating prior authorization reviews for consistency, addressing improvement opportunities and presenting results to Pharmacy Operations Management and Moda’s Quality Improvement Committee
- Established Medication Utilization Evaluation Program, working closely with Clinical Pharmacist teams, providing provider outreach for impacted members, developing and maintaining timelines, and coordinated cross-department communications
Pharmacy Benefits Config. Coordinator/Auditor
Moda Health
06.2014 - 04.2015
- Worked closely with PBM to program pharmacy benefit changes and audit claims adjudication
- Resolved programming errors and answer benefits questions from customer service and account executives
- Developed thorough understanding of pharmacy benefit programming, IQ review and group application review
- Efficiently managed multiple projects with priorities/deadlines
Prior Authorization Coordinator
Moda Health
01.2014 - 06.2014
- Processing prior authorizations for Commercial plans
- Utilizing criteria to evaluate member prior authorizations
Prior Authorization Technician
Catamaran Insurance
11.2013 - 01.2014
- Processing prior authorizations for Medicare Part D members
- Utilizing criteria to evaluate member prior authorizations
Lead Pharmacy Technician
Safeway Pharmacy
06.2013 - 11.2013
- Traveled to multiple pharmacies and reduced inventory by over $200,000 in 3 months
- Led other technicians and staff pharmacists to create a well-managed and organized pharmacy
Special Services Pharmacy Processor/New Admit Coor
Payless LTC Pharmacy
08.2012 - 06.2013
- Reconcile new patient’s medications with physicians to create adherence packaging
- Communicated directly with doctors’ offices via telephone, fax and email
Certified Pharmacy Technician
Safeway Pharmacy
10.2009 - 07.2012
- Worked to reduce pharmacy inventory by over $115,000 via strategic ordering and allocation
- Proficient in all aspects of third-party billing, including COB and prior authorizations
- Provide superior customer service, including knowing over 75% of pharmacy customers by name
Education
High School Diploma -
Sandy High School
Sandy, OR 09.2004 - 01.2008
Timeline
Project Management Professional (PMP 3195444)
12-2021
Project Manager
Cambia Health
08.2021 - Current
Pharmacy Operations Quality Coordinator
Moda Health
04.2015 - 08.2021
Pharmacy Benefits Config. Coordinator/Auditor
Moda Health
06.2014 - 04.2015
Prior Authorization Coordinator
Moda Health
01.2014 - 06.2014
Prior Authorization Technician
Catamaran Insurance
11.2013 - 01.2014
Lead Pharmacy Technician
Safeway Pharmacy
06.2013 - 11.2013
Special Services Pharmacy Processor/New Admit Coor
Payless LTC Pharmacy
08.2012 - 06.2013
Certified Pharmacy Technician (CPT-0005827) (Expired 2021)
10-2009
Certified Pharmacy Technician
Safeway Pharmacy
10.2009 - 07.2012
High School Diploma -
Sandy High School
09.2004 - 01.2008
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