JIM CALANDRIELLO
Montville
Summary
Over 20 years of healthcare and financial experience with a proven record of high performance Experience in Health Plan, National Employer, Middle Market Employer, Labor and Public Sector segments for Commercial, Exchange, Medicare and Medicaid lines of business Managed a large team of 50 pricing analysts, actuaries and financial analysts responsible for renewing existing clients and winning new business Great leader focused on team development and growth Strong business acumen, critical thinking skills and high degree of decision-making skills Successful in developing relationships and inspiring confidence from internal and external constituencies at all levels Self-motivated with an exceptional ability to learn and adapt to new processes/applications quickly and able to work on multiple projects simultaneously Highly analytical thinking skills with demonstrated talent for identifying, scrutinizing, improving and streamlining complex work processes Ability to define problems, collect data, establish facts and draw valid conclusions Polished presentation skills, including internal Senior Staff, clients and benefit advisors/consultants
Overview
22
22
years of professional experience
Work History
Vice President, Underwriting
Prime Therapeutics
Eagan, Minnesota
01.2019 - Current
- Lead a team of 40 pricing analysts, actuaries and financial analysts responsible for underwriting financial offers for Employer (National and Middle Market) existing and prospect clients, Health Plan prospect clients, Specialty underwriting, Medical Pharmacy underwriting and Financial guarantees.
- Balance internal profitability and providing Sales and Client Engagement with competitive financial offers which allows Prime to profitably retain existing clients and win new clients.
- Collaborate with key internal stakeholders on strategic initiatives, such as Supply Chain 2.0 and Rebate Restatement.
- Evolve underwriting process to incorporate internal and external complexities (i.e. Cost Plus, AAC, Regulatory requirements, Best in Care, etc.).
- Partner with key internal stakeholders to leverage the appropriate risk mitigation strategies on behalf of Prime.
- Develop annual Pricing Guidelines, including Target Margin and Grants of Authority, by line of business.
- Responsible for Pricing Governance, including but not limited to developing and implementing new pricing strategies, reviewing competitive intelligence, firewall considerations and training.
- Provide underwriting support in the growth of the Medical Pharmacy product. This includes data analysis, pricing options, savings, ROI and post-launch monitoring.
- Critical focus on process and tool enhancements.
- Strong understanding of the underwriting, RFP and contracting process.
- (Formerly Magellan Health)
- Built imperative internal relationships with Sales, Account Management, Supply Chain, Clinical and Legal, which is a key to Prime’s long-term success.
- Negotiate pricing offers externally directly with clients and consultants.
Vice President of Pricing, Commercial Division
Cigna
Bloomfield, CT
01.2017 - 01.2019
- Managed a team of 50 pricing analysts and actuaries responsible for underwriting financial offers for all employer, public sector, labor and federal clients ranging from $5M to $4B in annual drug spend.
- Over 96% retention rate for existing clients 5 straight years.
- Critical focus on process and tool improvements through Finance Transformation initiatives.
- Built imperative internal relationships with Sales and Account Management, Supply Chain and Legal, which is a key to the organization’s success.
- Responsible for evaluating the financial impact for new strategic initiatives and new pricing strategies.
- Negotiated pricing offers directly with clients and benefit advisors/consultants.
- Consistently partnered with cross-functional teams within the organization to ensure pricing offers are provided in a timely and accurate manner.
- Responsible for underwriting Medicare Part D Employer Group Waiver Plans (EGWP) self-insured and fully-insured offers, which require an understanding of Centers for Medicare and Medicaid (CMS) requirements.
- Participated in bi-weekly Strategic Pricing Committee and Executive Pricing Council, which are intended to drive strategic initiatives throughout the organization.
- (Formerly Express Scripts and Medco Health Solutions, Inc.)
- Senior Director of Pricing, Commercial Division 2013 - 2017
- Director of Pricing, Commercial Division 2011 - 2012
- Senior Manager, Key Accounts Pricing 2008 - 2011
Senior Financial Analyst
Financial Analyst Group
01.2005 - 01.2007
- Conducted in-depth analyses to identify client-specific trend, explain past program performance and recommend opportunities for improvement.
- Provided analytical, quantitative and financial cost modeling assistance in support of Sales and Account Management, including plan design consultation and recommendations.
- Analyzed and recommended products and programs that were in the financial and clinical best interest of clients, patients and Medco.
- Presented analyses to key clients as part of Account Management team on a quarterly basis.
- Led complex ad hoc financial and consultative requests.
Senior Financial Analyst
CitiStreet
Somerset, NJ
01.2004 - 01.2005
Education
Master of Business Administration - Finance
Centenary College
Hackettstown, NJ11-2006
Bachelor of Arts - History
Rutgers University
New Brunswick, NJ05-1998
Skills
- Computer-literate performer with extensive software abilities
- Proficient in Microsoft Office
- Exceptional Organizational skills
- Ability to Work Under Pressure
- Critical Thinking and Problem Solving
Timeline
Vice President, Underwriting
Prime Therapeutics
01.2019 - Current
Vice President of Pricing, Commercial Division
Cigna
01.2017 - 01.2019
Senior Financial Analyst
Financial Analyst Group
01.2005 - 01.2007
Senior Financial Analyst
CitiStreet
01.2004 - 01.2005
Bachelor of Arts - History
Rutgers University
Master of Business Administration - Finance
Centenary College