Judith Ross

• Responsible for achieving sales targets and owning/managing relationships for assigned Accounts/Call Targets
• Assigned Accounts/Call Targets include Retail Pharmacy Leaders within the following Banners: Wal-Mart, Walgreens, CVS, Albertsons, Kroger, and HEB.
• Responsible for taking lead in creating/supporting the retail engagement strategy and key execution metrics required for assigned accounts.
• Ensured effective top down and bottom up account management to influence positive purchasing outcomes for HEPLISAV-B across assigned accounts/call targets.
• Worked with Retail Market Leader to analyze territory data and customer interactions to evaluate pharmacy account manager opportunity, strategy, messaging, and execution details.
• Developed and fostered relationships with key stakeholders who influence National/Region/District decision making creating mutually beneficial opportunities for growth and collaboration..
• Worked with Market Access on identifying and resolving Coverage and Adjudication obstacles as they arose within Retail Pharmacy.
• Connected with Director and Senior Director to provide quarterly business updates, performance needs, and field resource requests.
• Implemented data-driven decision-making strategies, leading to more informed business choices and positive outcomes.
• Actively participated in industry conferences and networking events, increasing company visibility and creating valuable connections with peers.
• Negotiated favorable contract terms with vendors and suppliers, resulting in significant cost savings without sacrificing service or quality standards.
• Developed competitive pricing strategies based on extensive market research data analysis.
• Championed corporate social responsibility initiatives that enhanced company reputation while positively impacting local communities.
• Assisted in organizing and overseeing assignments to drive operational excellence.
• Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
• Developed detailed plans based on broad guidance and direction.
• Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.

• Built from scratch and developed national territory for Department of Corrections customer segment, including Federal Bureau of Prisons, California Department of Corrections and Rehabilitaion (CDCR), Diamond Pharmacy, and 20 other state DOC programs.
• Account responsibility and business ownership for assigned accounts in the DOC segment and other National/Regional Accounts to grow HEPLISAV-B (a hepatitis B vaccine) sales
• Worked with Market Leaders to support and pull through HEPLISAV-B sales for other accounts as directed
• Collaborated with all levels of Dynavax Senior leadership team to develop strategies and execution plans that enable HEPLISAV-B to meet its full revenue potential in Department of Corrections segment.
• Achieved sales targets for assigned federal and state correctional facilities and other corrections related customer targets.
• Managed and executed detailed plans – with accountability markers – for key targets in the corrections segment.
• Built and maintained C-suite relationships with clinical, financial and operational decision makers within the corrections segment.
• Worked with Market Leader to execute sales & marketing strategies to support HEPLISAV-B adoption within assigned accounts.
• Worked in tandem with Medical Affairs and Medical Science Liaisons to develop comprehensive medical plans to implement a hepatitis-B immunization program.
• Developed and communicated strategic account plans and monitored progress toward those plans.
• Responsible for understanding market dynamics and customer business models to identify opportunities and developed strategies and tactics across assigned accounts.
• Negotiated favorable contract terms with vendors and suppliers, resulting in significant cost savings without sacrificing service or quality standards.

• Special Project- Provide Market Access support, acting as a liaison between Dynavax Market Access and national payers, including PBM’s, Government payers, and IDN.s, triaging coverage and access issues as needed.
• Used established network of payer industry contacts to facilitate broader conversations leading to improved market access of Heplisav-B.

Business Operations and Management:

• Built from ground up and implemented the Part D component of a Medicare Advantage plan (MAPD) classified as a Chronic Special Needs Plan (C-SNP) for End Stage Renal Disease, representing growth from $0 to $4.6 million expenditures annually while expanding members from 0 to 600.
• Provided business oversight for operational aspects and decisions related to formulary and clinical program offerings of the PBM partner.
• Led end-to-end PBM contract negotiations and formulated policies and procedures to ensure compliance with Medicare Part D regulations.
• Exercised direct oversight of PBM partnership for contractual and regulatory obligations.
• Consistently met financial performance for profitability and operating income by executing strategies that align with the company’s short-term and long-term objectives.

Integrated Care Model:

• Developed synergies between hospital, dialysis clinics, financial management, urgent care, and home care, including transportation medical care.
• Partnered with all units of the Medicare Advantage Plan: Chief Medical Officer, VP Plan Operations, VP Utilization Management, VP Sales, and Director-level operations, enrollment, utilization management, marketing, regulatory affairs, and claims processing to ensure operational goals are met.

Quality Monitoring and Compliance:

• Conducted quarterly and annual quality monitoring for HEDIS, STARS, and other quality programs as necessary.
• Successfully led the Part D plan through internal and external audits including SOX-2 audits, CMS financial audits, CMS program audits, and state insurance board audits.
• Developed a work plan for future URAC accreditation and evaluated vendor relationships with Pharmacy Services Administration Organization, wholesaler, and third-party dispensing pharmacies.

Population Health Management:

• Performed population health analysis and implemented programs specific to population characteristics.
• Designed benefits for specialty medications (HepC and dialysis-related medications specifically).

Pharmacy Benefit Management (PBM):

• Managed formulary, prior authorization, and drug utilization review.
• Monitored pharmacy claim adjudication (Argus/DST platforms) and claims oversight.

Staff and Provider Training:

• Educated and trained customers regarding the Part D component of the Medicare Advantage plan, including large in-network provider groups, sales team, and member services team.
• Closely monitored staff activities to ensure operational metrics were achieved.

Reporting and Communication:

• Generated Part D status reports for the President and Vice-Presidents regarding spend and growth.
• Prepared marketing and patient correspondence related to the Part D program, ensuring compliance with Medicare marketing guidelines.

Collaboration and Advocacy:

• Collaborate with social workers to ensure patient access to life-sustaining services and medications.
• Utilize private foundations (National Kidney Foundation), charities, and local organizations for patient support and access to medications.

Authored

• White paper focusing on unique payment and reimbursement options for chronic special needs health plans.

Consulting Expertise:

• Exercised consulting expertise at the request of FHP President regarding operational deficiencies and long-term business strategy for FreseniusRx (FRx), a renal specialty pharmacy delivering to dialysis clinics and patient home delivery, wholly owned by Fresenius Medical Care.
  -Identified operational deficiencies and built a work plan to address them.
  -Participated in an executive taskforce, including CMO, CCO, Presidents, and Vice-Presidents to address prior authorization backlog.
  -Built long-term and short-term business strategies for FRx including classification strategy.
  -Partnered with outside consulting firms to incorporate strategy for URAC accreditation.
  -Developed payer strategy for direct contracting negotiations including seeking legal counsel for contract language.
  -Developed a dashboard for auditing external payers for reimbursement outliers.
  -Developed an auditing process of managed care contracts to measure and maintain compliance.
  

Reason for Departure: Position was eliminated due to the contract with CMS not being renewed for 2020.

Key Achievements:

• Successfully integrated hospital, dialysis clinics, and home care services to enhance patient care.
• Led the development and implementation of a value-based care model that improved patient outcomes and reduced costs.
• Ensured compliance with all regulatory requirements, leading to successful audits and improved quality ratings.

• Represented Humana Pharmacy Solutions to large medical groups, provider organizations and integrated delivery networks
• Supported the Humana Medicare Advantage Prescription Drug (MAPD) regions for all pharmacy activities of Humana’s Prescription Benefit Manager (PBM), determining the best possible tools and solutions that would help large provider groups and individual providers maximize their part D risk sharing thresholds.
• Managed MAPD divisions’/regions’ risk providers and Provider Organized Delivery Systems (PODS) for all pharmacy related needs
• Educated executives on best practices, market trends, and products and services in order to help them improve their productivity to achieve their desired goals
• Directed annual pharmacy benefit planning
• Served as a pharmacy benefit subject matter expert and trusted advisor to clients.
• Competently represented Humana Pharmacy Solutions Senior Products to over 30 large provider organizations in the Western Division through JOC meetings, one-on-one provider meetings, and executive level interventions.
• Supported the generation of new business by participating in prospecting opportunities with new clients.
• Contributed pharmacy and related perspectives to broader health and benefits projects including health management strategy.
• Partnered with PODS manager to present clinically sound alternative therapies to improve patient care and decrease overall part D spend thereby decreasing part D risk overall throughout region.
• Worked on cross-functional teams to improve overall STARS score throughout Western Division.

● strategies to improve outcomes, enhance cost-effectiveness, and increase member satisfaction.

Key Accomplishments:

• Proposed clinically effective alternative therapies, significantly enhancing patient care and reducing Part D expenditures.
• Actively participated in prospecting opportunities, generating an increase in client acquisitions and market reach.
• Worked with cross-functional teams to strategize improvement initiatives, enhance STARS scores, and achieve key metrics.

Supervisor:

• Directed and supervised a team of 30+ pharmacists and technicians in formulary, drug utilization review, and medication therapy management.
• Monitored and reported on call center metrics including quality, continuous action plans and ensuing results.
• Training- Oriented and trained pharmacy interns, residents, technician trainees, and newly hired personnel.

Staff Pharmacist:

• Performed drug utilization reviews and improved drug regimens through clinical optimization and cost reduction
• Performed formulary analysis for employer-led health plans and commercial health plans
• Communicated professionally with physicians, nurses, and other healthcare professionals regarding medication related issues
• Documented competency by routinely documenting clinical pharmacy interventions.

Key Accomplishments:

• Implemented the Work at Home Beta testing initiative, serving as one of the first 30 pharmacists in testing remote operations.
• Developed and presented Custom Care Mail department presentations to prospective clients and senior management, effectively communicating the department's capabilities and fostering client engagement and strategic partnerships.

• Presented formulary alternatives to provider groups.