ADEYINKA ADEKANOLA
Mansfield,TX
Summary
Dynamic professional with over 8 years of experience in operational and leadership management, specializing in the coordination and process enhancement. Proven expertise in developing strategic management systems and optimizing healthcare operations with a strong emphasis on value-based care. Committed to achieving organizational goals in alignment with specified mission and vision. A results-oriented approach ensures continuous improvement and operational excellence.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Provider Relations Specialist - Pharmacy Operations
Center Well Pharmacy / Humana
2021 - Current
- - Maintain a significant liaison/relationship through constant collaboration and communication between healthcare providers and the pharmacy for effective patient care and medication management.
- - Initiate prescriber script staging procedures for intake and processing, including coverage preferences and restrictions.
- - Implement healthcare provider script screening notification, processes, and prescription/medication inquiry.
- - Enable an excellent integration of healthcare provider services with pharmacy operations to ensure an expected outcome that conforms to clinical protocols.
- - Implement and ensure the appropriate coverage and billing protocols while collaborating with providers to ensure effective formulary management.
- - Initiate the execution of procedural protocols for prior authorization requests and appeals, while monitoring the successful completion of the three-party processing cycle (pharmacy, prescriber, and insurance).
- - Perform reviews of provider-related formulary checks, exception reviews, and execution of regularizations as required.
- - Perform a pre-evaluation of drug utilization review notifications with healthcare providers prior to clinical assessment and the selection of alternative drug therapy.
- - Execute operational tasks in collaboration with other multidisciplinary units and departments to facilitate and implement patient-centric care approaches that guarantee the optimization of medication therapy that aligns with clinical and operational guidelines.
- - Ensure compliance with professional guidelines in conformance with HIPAA regulations.
Head/Team Lead – Pharmacy Operations
CVS Caremark / Pharmacy
01.2014 - 01.2021
- - Coordinate the team’s daily activities to ensure workflow efficiency and conformity to operational procedures, including accessing and transcribing script orders from provider sources, ensuring accurate interpretation, and initiating process start-up as accordingly.
- - Manage the execution of prescription processing based on features, specifications, and required procedural guidelines.
- - Coordinate the team’s activities on implementing patient care queue outreach and effecting process updates, including notifications for prescription outreach, particularly for specified or identified maintenance medications.
- - Oversee teams’ appropriate billing procedures as indicated via coverage plan, and advise patients, authorized caregivers, and prescribers as procedurally and professionally required.
- - Provide continuous on-the-job training support to ensure dissemination of up-to-date knowledge on compliance protocols, and service and product knowledge.
- - Ensure the effective coordination of a customer and patient-centric operational process to achieve a satisfactory patient outcome.
- - Ensure appropriate monitoring of probable risks of medication errors and other likely safety issues to guarantee successful patient safety outcomes.
- - Coordinate the performance of pre-audit cross-checks and post-audit regularizations as required, ahead of internal and external audit exercises, to ensure quality control and adherence to state and federal regulations.
- - Supervise inventory and stock management of medications in classes, as appropriate, according to classification guidelines.
- - Ensure the team’s compliance with professional guidelines in conformity with HIPAA and other privacy regulations.
Zonal Business Strategy and Development Manager
ProHealth (HMO) Limited, SW Zonal Office, Nigeria
01.2010 - 01.2013
- - Coordination of the leadership of zonal branches in the development of business strategies that are location-tailored towards targeting clients, physician networks, healthcare facilities, and providers for an established within-network service and care coverage.
- - Ensure the constant availability and management of the consortium of primary care providers as the service supply chain for care contacts, providing services in the zonal regional area.
- - Coordinate the successful establishment and approval of business relationships within the region with high-standard medical facilities for accreditation as healthcare providers (HCPs).
- - Manage the coordination of the zonal region’s drive towards the propagation of continuous preventive care for clients/patients, including periodic check-ups, health screenings, and inoculations, as measures of care maintenance.
- - Approve the business strategy of branches to drive the propagation of key selling points, such as lower copayment, deductibles, and premiums, as an HMO within the zonal region, and among industry competitors.
- - Coordinate the zonal business branches in arranging business-driven sensitization initiatives, workshops, and awareness creation for the workforce of prospective and existing corporate entities within the region, aiming to achieve a patient-centric outcome.
- - Coordinate the collaboration of different zonal departments to drive a unified and seamless execution of developed business strategies and alignment of purpose.
- - Oversee audit exercises for HCPs' adherence and compliance with regulatory specifications as required by government regulatory laws and company policy.
- - Periodically evaluate and track the zonal region’s performance indices and metrics as per key performance indicators (KPIs) to measure the effectiveness of business strategies and ensure meeting the organizational targets and goals.
Business Development Manager / Branch Head - Retail Market
Enterprise Bank, Limited
01.2004 - 01.2010
- - Oversee the branch workforce's ability to effectively create and maintain the branch's business relationship with individual/corporate customers.
- - Create and execute business development strategies to improve branch performance and market share.
- - Identify growth opportunities and develop actionable plans that align with the bank's strategic goals.
- - Continuously liaise with high-net-worth customers to ensure excellent service delivery towards enabling growth and retention of the customer base.
- - Coordinate the creation, appraisal, and processing of income-generating transactions (lending, investments, and consultancy) for the branch.
- - Creation and implementation of the branch's monthly, quarterly, and annual performance and income generation reports.
- - Coordination of the branch's workforce activities toward meeting the quarterly assigned branch's performance metrics and goals.
- - Oversee the creation of environment/location-driven customized products towards achieving customer interest, dedication, and satisfaction while accomplishing organizational goals.
- - Periodically carry out market analysis and research to identify developing trends, customer desires, and strategic competitive alignments to create and navigate a profitable business environment.
- - Constantly ascertaining that all banking operational procedures conform to regulatory demands and internal guidelines.
- - Supervise risk assessment procedures to alleviate possible financial and operational liabilities.
Education
Master of Science - Healthcare Sciences (MSHS), Clinical Operations and Healthcare Management
The George Washington University
Washington, DC01-2025
Diploma - Pharmacy Operations
Penn Foster Career College
Scranton, PAMaster of Business Administration - Business Development and Marketing
Ladoke Akintola University of Technology
Post Graduate Diploma - Management Studies
Ladoke Akintola University of Technology
Bachelor of Science - Computer Science
The Federal Polytechnic
Skills
- Allscripts, Argus Health System, Rx Connect Pro,
- ERx Post, RPA Launcher, and Microsoft Office
- Health plan operations
- Healthcare strategic business relationships
- Member enrollment
- Provider relationship management
- Time management
- Teamwork and collaboration
- Problem-solving abilities
- Excellent communication
- Critical thinking and Problem-solving
Certification
- Certified Professional in Healthcare Quality (CPHQ) (National Association of Healthcare Quality) In Progress
- Certified Pharmacy Technician (CPht) (Pharmacy Technician Certification Board) 2015
- Texas State Registered Pharmacy Technician (RPht) (Texas State Board of Pharmacy) 2015
- Basic Life Support (BLS) Provider
- National Pharmacy Technician Association Member
Timeline
Head/Team Lead – Pharmacy Operations
CVS Caremark / Pharmacy
01.2014 - 01.2021
Zonal Business Strategy and Development Manager
ProHealth (HMO) Limited, SW Zonal Office, Nigeria
01.2010 - 01.2013
Business Development Manager / Branch Head - Retail Market
Enterprise Bank, Limited
01.2004 - 01.2010
Provider Relations Specialist - Pharmacy Operations
Center Well Pharmacy / Humana
2021 - Current
Master of Science - Healthcare Sciences (MSHS), Clinical Operations and Healthcare Management
The George Washington University
Diploma - Pharmacy Operations
Penn Foster Career College
Master of Business Administration - Business Development and Marketing
Ladoke Akintola University of Technology
Post Graduate Diploma - Management Studies
Ladoke Akintola University of Technology
Bachelor of Science - Computer Science
The Federal Polytechnic
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