Allison Akin

• Led organizational transition by guiding Clinical Criteria Operations team integration under new leadership, ensuring continuity and alignment with evolving business objectives.
• Championed innovation through the design and launch of strategic initiatives for the Pharmacy Utilization Management (PUMA) program and broader organizational transformation.
• Optimized departmental efficiency by implementing waste-reduction strategies and aligning workflows with PUMA performance goals.
• Defined team priorities and built performance tracking systems using Wrike to enhance accountability and transparency.
• Set clear performance benchmarks for staff and delivered targeted coaching to support professional growth and goal attainment.
• Conducted structured performance evaluations and provided actionable feedback to elevate individual and team capabilities.
• Identified skill gaps and developed targeted training programs and SOPs to strengthen core competencies and operational readiness.
• Leveraged data analytics to inform strategic decisions, uncover improvement opportunities, and drive measurable business outcomes.
• Streamlined quality assurance programs to ensure compliance, consistency, and continuous improvement across clinical operations.
• Maintained cross-functional communication between vendors and financial controllers to support seamless collaboration and fiscal oversight.
• Owned vendor management processes, including Statements of Work, monthly budget approvals, and forecasting for contracted resources.
  

Evolving Leadership and Oversight Responsibilities September 2014 – May 2025

• March 2024 – May 2025: Lead a multi-tiered team including managers, individual contributors, and three offshore vendor groups within the Clinical Coverage Determination Algorithms Operations unit.
• March 2020 – February 2024: Oversaw three high-impact teams within Clinical Operations Formulary Management —Clinical Pharmacy System Configuration Team, Clinical Implementation Analysts, and Clinical Coverage Determination Algorithms Operations—driving operational excellence and strategic alignment.
• September 2014 – February 2020: Directed Clinical Pharmacy System Configuration Team and Analysts, fostering a culture of accountability and continuous improvement.

Strategic and Operational Contributions September 2014 – May 2025

• Lead enterprise-wide implementation of health plan business solutions into Cigna's Utilization Management (UM) intake tools and adjudication systems, ensuring timely, consistent, and scalable integration.
• Enhanced stakeholder experience by streamlining processes and fostering cross-functional collaboration across clinical, technical, and business domains.
• Orchestrated strategic initiatives with internal and external stakeholders, managing complex projects that impacted multiple teams and business units.
• Built a forward-looking pipeline for Coverage Determination Algorithms Operations, integrating forecasting, quality assurance, and training programs to support long-term operational sustainability.
• Directed change management efforts, overseeing implementation workflows, reporting frameworks, and quality assurance protocols to support seamless transitions and performance tracking.
• Optimized resource allocation, aligning team capabilities and vendor partnerships with evolving project goals and business priorities.
• Maintained financial oversight by managing Statements of Work, coordinating monthly budget approvals, and forecasting for vendor and contractor engagements.
• Sustained high-impact communication channels between vendors, financial controllers, and internal teams to ensure transparency, accountability, and collaborative success.
• Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives. Defined, implemented, and revised operational policies and guidelines.
• Worked collaboratively with functional leaders to implement new procedures and corrective actions to improve quality.
• Spearheaded and implemented new projects providing business requirements to expand scope of engagement.

• Provide clinical leadership for Medicare Part D, Medicare, and commercial coverage determination reviews, ensuring timely, evidence-based decisions that comply with URAC accreditation standards, CMS regulations, and state-specific mandates
• Oversee integration of drug coverage policies into the Criteria Manual and PAHub platform, serving as subject matter expert (SME) for cross-functional stakeholders including Coverage Policy, Clinical Programs, Contracting, and Specialty Pharmacy.
• Lead strategic planning and execution of drug coverage algorithm builds to support system enhancements, regulatory changes, and operational scalability.
• Drive continuous improvement initiatives leveraging data analytics and system tools to reduce unnecessary pharmacy claim edits, lower prior authorization (PA) volume, and optimize drug coverage algorithm performance recognized with a Cigna Quarterly Champion award.
• Act as subject matter expert for pharmacists and managers on adjudication logic, coverage policy interpretation, system updates, and system functionality.
• Design and deliver targeted training, job aids, and coaching to frontline pharmacists and technicians to support clinical accuracy, operational efficiency, and regulatory compliance.
• Serve as single point of contact for Sales and SME for Pharmacy Claims Enhancement initiatives, ensuring alignment between clinical operations and business development.
• Collaborate with compliance, medical directors, and IT to support audit readiness, system functionality, and enterprise-wide clinical strategy.
  

• Delivered high-volume, clinically sound coverage determinations for Medicare Part D, Medicare, and commercial plans, consistently exceeding quality and turnaround
• Applied evidence-based criteria and regulatory standards (CMS, URAC, state mandates) to ensure compliant, audit-ready decisions.
• Acted as SME for PAHub, Argus, and coverage determination algorithms, supporting system enhancements and cross-functional collaboration.
• Led training and coaching initiatives for pharmacists and technicians, improving accuracy and operational efficiency.
• Contributed to inter-rater reliability reviews and formulary council meetings to maintain consistency and clinical alignment.
  

BS in Pharmaceutical Science (May 2001)

Doctor of Pharmacy, Pharm D (May 2003)