JAMES HUA
Tampa
Summary
Executive leader with 15+ years of experience across managed care, PBM strategy, and clinical operations. Specializes in formulary governance, drug utilization management, and Medicare Part D performance optimization. Consistently delivers measurable improvements in Star Ratings, total cost of care, and clinical outcomes through data-driven strategy, provider engagement, and benefit design. Recognized for leading cross-functional initiatives that generate multimillion-dollar savings while maintaining regulatory compliance and quality excellence.
Overview
12
12
years of professional experience
Work History
Director of Pharmacy
SECUR HEALTH PLAN
Tampa, FL
05.2024 - Current
- Led enterprise formulary and utilization strategy across Medicare Advantage populations, improving Star performance metrics and adherence outcomes within the first year.
- Developed analytics platform tracking drug spend, prescriber behavior, and utilization trends, enabling leadership to identify cost drivers and reduce spend by $1M annually.
- Partnered with actuarial and finance teams to influence benefit design and bid strategy for upcoming plan year cycles.
- Directed risk adjustment initiatives improving Risk Adjustment Factor capture through integration of medication data and provider documentation workflows.
- Ensured 100% compliance with CMS reporting requirements and audit readiness across all submissions.
- Implemented workflow improvements to enhance medication delivery efficiency and accuracy.
MTM Consultant
ASPEN RXHEALTH
Tampa, FL
01.2019 - Current
- Conduct comprehensive medication reviews improving adherence and clinical outcomes across diverse patient populations.
- Identify therapy gaps and implement targeted interventions to improve chronic disease management.
- Collaborated with healthcare providers to develop patient-centered care plans tailored to individual needs.
Director of Pharmacy Services
BETTER HEALTH GROUP
Tampa, FL
06.2022 - 04.2024
- Delivered $9M annual savings across 14+ health plans by implementing formulary adherence programs and therapeutic optimization strategies.
- Reduced Part D cost per member per month by 5% within 12 months through targeted provider interventions and prescribing pattern changes.
- Improved Generic Dispense Rate across 300+ providers and enhanced prescribing efficiency through structured education campaigns.
- Launched chronic disease programs impacting 1,000+ patients, reducing hospitalizations by 5% and improving diabetes control outcomes.
- Achieved and sustained 4.5-5 Star quality ratings across multiple contracts through adherence and quality measure optimization.
Pharmacy Supervisor
CORAM CVS
Tampa, FL
12.2021 - 06.2022
- Improved operational efficiency by 15% within 6 months by redesigning workflow processes in sterile compounding environment.
- Maintained full regulatory compliance across all sterile preparation standards and quality audits.
Pharmacy Manager
WALGREENS
06.2019 - 12.2021
- Led team processing 800+ prescriptions daily while improving adherence rates by 15% through synchronization programs.
- Reduced customer wait times by 20% within one year by optimizing staffing models and workflow design.
- Managed daily pharmacy operations, ensuring compliance with regulatory standards and safety protocols.
Director of Operations
PRECISIONMED
Tampa, FL
08.2014 - 02.2019
- Reduced medication-related expenses by 15% through formulary alignment and payer collaboration strategies.
- Achieved 95% prior authorization approval rate through process redesign and payer engagement.
- Grew annual revenue to $2M while maintaining 100% audit compliance and operational accuracy.
Education
Doctor of Pharmacy - Pharmacy
University of Florida
Gainesville, FL05-2011
Skills
- Formulary Strategy
- Pharmacy Benefit Design
- Drug Utilization Management
- Medicare Part D Optimization
- CMS Star Ratings
- Medication Therapy Management
- PBM Contracting & Alignment
- Cost Containment Strategy
- Regulatory Compliance (CMS, Federal & State)
- Value-Based Care Models
- Risk Adjustment (RxHCC/Risk Adjustment Factor)
- Clinical Program Development
- Data Analytics & Reporting
- Provider Engagement
- HEDIS Measures
- Specialty Drug Strategy
- Rebate Optimization
- P&T Committee Support
- Utilization Review
- Total Cost of Care Reduction
Timeline
Director of Pharmacy
SECUR HEALTH PLAN
05.2024 - Current
Director of Pharmacy Services
BETTER HEALTH GROUP
06.2022 - 04.2024
Pharmacy Supervisor
CORAM CVS
12.2021 - 06.2022
Pharmacy Manager
WALGREENS
06.2019 - 12.2021
MTM Consultant
ASPEN RXHEALTH
01.2019 - Current
Director of Operations
PRECISIONMED
08.2014 - 02.2019
Doctor of Pharmacy - Pharmacy
University of Florida