Cody Brown

Responsibilities:

• Developed and maintained collaborative partnerships with ePA vendors to optimize production support services.
• Maintained and updated vendor tracking logs, ensuring timely sharing with clinical operations technology and vendor teams.
• Facilitated the integration of modifications submitted by operations teams to optimize downstream workflows.
• Analyzed ePA cases through partnerships with vendors and direct engagement with account managers.
• Engaged with operational partners to drive effective communication on product enhancements, ensuring alignment with production goals.
• Facilitated escalation and management of client requests for enhancements and changes.
• Collaborated with stakeholders to identify and execute necessary changes to carrier and vendor UI forms.
• Managed dissemination of vendor system update information to ensure operational alignment and clarity.
• Directed the revision and enhancement of vendor prescriber educational materials to support effective communication.
• Delivered comprehensive training on vendor user interface to enhance client and operational efficiency.

Clinical Operations ePA Case Management

Manages internal Operations and Account Management requests by providing user experience subject matter expertise to support use case development

Responsibilities:

• Coordinates problem analysis, solution validation, risk management, escalation, and stakeholder engagement for ePA production activities, inclusive to cases in Prior Authorization Systems
• Partners across Books of Business (BoB) and associated internal Prior Authorization Systems and Production Support to research and solve complex ePA issues
• Runs SQL queries to pinpoint data required for research
• Leverages claims adjudication RXClaim (AS400) system, internal PA systems, and vendor UIs to navigate for eligibility, carrier, member and claims data
• Tests cases in vendor User Interface (UI), and recreates scenarios in UI to mimic the Prescriber experience
• Communicates with vendors via applicable reporting systems
• Provides research results to reporting parties
• Partners with Prior Authorization Administration when System behavior does not align with prescriber and client expectations
• Leverages Salesforce to communicate with Account Management Teams for case updates

ePA Internal Partnerships

Drives relationships with business partners related to ePA products and serves as a SME with Pharmacy Segment Services (PSS) Operations, IT Development, IT Support, IT Project Management, Product Development, Health Care Benefit (HCB – Aetna), Account Management, Finance, HR, Regulatory Affairs, Legal, CVS Fraud Waste and Abuse

Responsibilities:

• Engages with new clients and prescribers in the Onboarding process for ePA, and existing clients to improve process
• Engages with leadership to support ePA product demonstrations when requested
• Engages with all areas of the business touching ePA to ensure integrity and case flow as expected
• Proposes solutions to areas of business to define, analyze and problem solve to improve ePA case outcomes

Welcome Season and Mid-Year Change Preparation

Engages with Internal PA Operation's partners and Vendors to prepare for upcoming changes during Midyear and for 1/1

Responsibilities:

• Drives conversations with PA Operations related to ePA carrier changes
• Aligns Commercial, Medicaid and Medicare Operations for LOBs for new carriers
• Communicates vendor cutoff and code/change freeze timelines with Operations and Account Management
• Manages carrier data files containing changes, and applies system changes internally
• Submits changes to vendors, managing new changes such as carrier data, form's and form data
• Initiates reporting requests for Operations, providing visibility to ePA volume for new carriers

ePA Carrier Management

Manages new ePA carriers and termination changes submitted by Operations

Responsibilities:

• Actively manages ePA carrier data in appropriate UI ensuring ePA is flowing or termed per dates requested
• Leverages data in UI to research complex eligibility case issues
• Internally partners with data teams, operations and vendors to resolve issues

ePA Vendor Incidents

Manages ePA vendor incidents by providing up-to-date information during vendor outages, Internal PA System Outages, Eligibility System outages

Responsibilities:

• Manages Communications distribution lists with vendors, including updates/changes
• Engages with vendors and business to disseminate information during vendor or internal business system outages
• Partners with Incident management to provide up-to-date information from the vendor or internal business partners regarding outages

Responsibilities:

• Spearheaded development, execution, and maintenance of project concepts to drive improvements and align best practices across business units.
• Executed improvement projects and integrated technology solutions to optimize performance and outcomes.
• Oversaw strategic business leadership in user-centered discovery design and executed full-cycle product implementation.
• Advised on user experience best practices during project requirements gathering and contributed to comprehensive use case development.
• Evaluated and optimized testing methodologies to leverage industry best practices effectively.
• Guided teams through requirement development and test case execution to enhance project outcomes.
• Facilitated problem analysis, solution validation, risk management escalation, and stakeholder engagement for all technology initiatives.
• Oversaw transition processes to integrate changes into downstream operational teams.
• Led cross-functional collaboration with stakeholders and business partners to optimize pharmacy segment services operations. Oversaw IT development and project management efforts to align with organizational goals. Coordinated with finance, HR, regulatory affairs, and legal departments to enhance account management processes.
• Established and maintained effective communication channels with senior and executive leadership to enhance organizational synergy.
• Navigated complex regulatory and accreditation landscapes while delivering tailored solutions to meet diverse client needs in a production setting.
• Developed and maintained strategic partnerships with electronic prior authorization system vendor and internal PA system personnel to ensure seamless integration.
• Achieved alignment of CVS Health applications with operational priorities through effective management of clinical initiatives. Identified and mitigated risks and challenges related to proposed enhancements, driving optimal performance across the portfolio.
• Engaged with PA teams to identify and implement efficiencies in prior authorization workflows.
• Ensured adherence to all relevant regulations and performance guarantees to maintain accreditation standards for URAC and NCQA.

Responsibilities:

• Provided strategic support to CIO and Director of Information Systems in leading IT department initiatives and project management. Collaborated with leadership to establish direction for IT oversight and project execution. Drove departmental efficiency and alignment with business goals through effective implementation. Engaged with external partners and internal teams to identify solutions and elevate service quality for stakeholders.
• Achieved successful project outcomes by managing scope and timelines effectively. Delivered high-quality results through strategic oversight of simultaneous projects. Maximized resource utilization to drive project success and meet stakeholder expectations.
• Cultivated strong relationships with project stakeholders to promote effective communication. Oversaw connections between internal teams and external IT vendors, aligning expectations and processes for successful project execution. Drove collaboration across groups to ensure project alignment and efficiency.
• Streamlined communication processes to relay critical information between Director of IS CIO and IT department efficiently.
• Engaged with IT management to optimize methodologies and ensure data-driven analysis for informed decision-making.
• Drove continual process enhancement by formulating and optimizing policies and procedures aimed at establishing operational efficiency and effectiveness of IT initiatives alongside CIO and Director of IS.
• Represented IT department in internal and external meetings as designated by CIO or Director of IS.
• Directed communication and collaboration regarding IT project timelines across internal departments.
• Directed staff responsibilities and ensured effective project/program execution through close collaboration with CIO and Director of IS.
• Co-developed project plans, goals, and budgets between IT and OFH stakeholders. Review progress for departmental goals, objectives, and strategies in conjunction with the CIO and Director of IS.
• Oversaw the analysis of project scopes and timelines to provide CIO with relevant insights. Developed and maintained comprehensive reports to facilitate informed decision-making for CIO.
• Administered vacation planning and managed paid time-off requests to ensure departmental coverage.
• Conducted thorough evaluations alongside CIO and Director of IS to identify and select qualified candidates for IT department roles.
• Collaborated with CIO and Director of IS on special projects and tasks as required to enhance overall IT strategy.

Responsibilities:

• Led initiatives in partnership with executive management team to drive organizational objectives. Oversaw special projects while maintaining strict confidentiality and professionalism. Coordinated cross-departmental efforts to enhance project outcomes.
• Streamlined executive calendar management, enhancing scheduling efficiency for meetings and appointments. Coordinated travel and logistical arrangements, contributing to seamless operations.
• Coordinated with executive team to keep team members informed of upcoming commitments and responsibilities, implementing follow-up strategies as needed.
• Engaged with various corporate divisions to uphold OFH standards and support executive directives from the CEO's office.
• Established a communication bridge that promoted productive interactions between CEO and departments, reinforcing organizational integrity and support.
• Facilitated effective administrative board and committee meetings by delivering comprehensive agendas and minutes. Drove follow-up initiatives from meetings, resulting in timely task completion and enhanced operational efficiency.
• Oversaw organizational functions related to meetings by managing logistics, including venue selection and agenda preparation. Facilitated effective communication through diligent follow-up tracking and resource procurement.
• Produced high-quality reports, letters, memoranda, and correspondence through meticulous execution and proofreading. Developed correspondence and reports that effectively addressed assigned responsibilities.
• Led project development initiatives by prioritizing and addressing simultaneous needs. Oversaw resolution of conflicts to maintain project momentum. Drove projects to completion through proactive management and adherence to deadlines.
• Supported strategic planning of internal and external events to enhance team collaboration and leadership engagement.
• Maintained accurate records of vacation schedules for corporate employees, ensuring seamless coordination for executive assistant activities.
• Designed and updated reports and presentations to effectively communicate key information as instructed.
• Executed management of various tasks and projects to ensure timely completion.

Responsibilities:

• Led membership department in alignment with organizational mission and strategic objectives. Directed team efforts to foster member relationships and drive retention. Championed initiatives that enhanced operational efficiency and member experience.
• Analyzed submitted membership applications for accuracy and completeness, facilitating efficient processing.
• Delivered continuous coaching and mentoring to membership staff to ensure high standards of professional service.
• Curated and presented monthly list of new member candidates for member communication and CEO evaluation.
• Organized and delivered monthly training classes for new members, fostering engagement and promoting retention.
• Oversaw maintenance of membership records and ensured accurate information availability on member website.
• Managed inquiries and complaints, ensuring comprehensive resolution of membership concerns.
• Collaborated with CEO to advance strategic initiatives that promote organizational growth and success.
• Achieved 97% compliance in annual broker certification for dues renewal through diligent oversight and process management. Maintained adherence to California Association of Realtors standards consistently.
• Regularly reviewed and updated membership forms to facilitate member access and compliance.
• Monitored and logged daily monetary deposits from member services staff, maintaining precise financial records.
• Delivered exceptional customer service to enhance member and guest satisfaction.
• Provided detailed information on membership benefits and service offerings to enhance customer understanding.
• Served as primary liaison to association committees to enhance collaboration and streamline decision-making processes.
• Oversaw realtor store operations, ensuring effective inventory management and sales monitoring.
• Executed membership staff functions on an as-needed basis to uphold organizational standards and member satisfaction.
• Managed payment transactions for dues and charges, ensuring timely updates to member account balances.
• Managed processes for issuing and monitoring MLS whistleblower violations to ensure compliance with organizational standards.