Summary
Overview
Work History
Education
Skills
Leadership
Awards
Research
Timeline
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Kyle Knudsen

South Weber,UT

Summary

Dynamic healthcare professional with extensive experience in managed care pharmacy, formulary strategy, and clinical program development. Proven expertise in optimizing healthcare strategies to drive access and outcomes in different lines of business. Exceptional leadership, analytical, and stakeholder engagement skills with a strong commitment to patient-centric solutions.

Overview

4
4
years of professional experience

Work History

Clinical Account Executive - Health Plan Division

Express Scripts Inc.
10.2022 - Current
  • Leads formulary strategy for Medicare, commercial, and exchange lines of business for multiples health plan clients.
  • Monitors industry trends and competition, adjusting sales strategies accordingly to maintain a competitive edge in the market.
  • Analyzes and presents rebate opportunities to meet client-specific financial goals
  • Provided exceptional customer service, addressing client concerns promptly and effectively to ensure long-term loyalty.

Prior Authorization Appeal Reviewer - Per Diem

Medical Review Institute of America (MRIoA)
05.2022 - Current
  • Reviews commercial and Medicaid prior authorization (PA) appeals for both pharmacy and medical drugs against the plan’s PA policy.
  • Reviews clinical literature and guidelines to determine if off-label use or an exception to the plan's policy can be granted.
  • Ensures accuracy in the documentation of my review process, findings, and overall appeal determination.

Senior Clinical Pharmacist

IngenioRx
07.2021 - 10.2022
  • Oversaw and directed strategies for Elevance Health's Medicare Stars strategy ratings, spanning 1.6M lives.
  • Negotiated vendor contracts and implemented pharmacy adherence-focused programs upon securing funding through the executive leadership team.
  • Improved data exchange processes with vendors by implementing secure file transfer protocols (SFTPs).
  • Analyzed and presented program outcomes to executive leadership team.


PGY-1 Managed Care Pharmacy Resident

Anthem Inc / IngenioRx
07.2020 - 06.2021
  • Completed rotations in specialty cost of care, traditional cost of care, analytics, account management, medical fraud, waste and abuse, P&T, among others.
  • Conducted research projects to advance the field of pharmacy practice and contribute to improved patient care methodologies.

Education

MBA -

Roseman University of Health Sciences
South Jordan, UT
06-2020

Doctor of Pharmacy (PharmD) -

Roseman University of Health Sciences
South Jordan, UT
05-2020

Skills

  • Client relationship building
  • Account management
  • Written and verbal communication
  • Formulary Development
  • Contract negotiation
  • Research and analysis
  • Vendor management
  • Strong presentation skills

Leadership

Medicare Formulary Strategy Residency Preceptor | Express Scripts (ESI)
Oct 2023 – Present
- Created and implemented residency learning objectives for Medicare formulary strategy.
- Provided mentorship and strategic guidance to residents in the program.

Leadership and Professional Development Residency Preceptor | Express Scripts (ESI)
Oct 2023 – Present
- Started this new rotation and created curriculum that focuses on developing leaders in managed care by goal setting, presentation skills, relationship building, etc. 

AMCP Student Chapter Diplomat | Roseman University
Nov 2024 – Present
- Mentor for students of Roseman University who have an interest in managed care.

Medicare STARs Residency Preceptor | IngenioRx
July 2021 – Oct 2022
- Expanded rotation to provide access to other STARs-related projects, spanning both Part-C and Part-D.
- Oversaw learning objectives, project initiatives, and resident development.

Awards

- Dean’s Award: Given to one graduating student for outstanding academic and professional achievements.
- AMCP Student Chapter Member of the Year: Given to one student chapter member based on their contributions to managed care pharmacy.
- MBA and College of Pharmacy Scholarships: Awarded for academic and leadership excellence.

Research

- Knudsen, Kyle D; Davis, Deborah; Nguyen, Kelsey; Alcoser, Rosalia; Gorseline, Kevin. Retrospective Study on the Effectiveness of a High-Touch Pharmacist Program for the Medicare Stars Adherence Measure. Academy of Managed Care Pharmacy (AMCP) Annual Conference; March 2021; Virtual.  
- Knudsen, Kyle D; Spjut, S. Russell; Jarmoszko, Julia. Retrospective Analysis on Claims Utilization Data for Medications Indicated to Treat Osteoporosis in the Medicare Part D Population. Academy of Managed Care Pharmacy (AMCP) Nexus Conference; October 2019; National Harbor, MD.

Timeline

Clinical Account Executive - Health Plan Division

Express Scripts Inc.
10.2022 - Current

Prior Authorization Appeal Reviewer - Per Diem

Medical Review Institute of America (MRIoA)
05.2022 - Current

Senior Clinical Pharmacist

IngenioRx
07.2021 - 10.2022

PGY-1 Managed Care Pharmacy Resident

Anthem Inc / IngenioRx
07.2020 - 06.2021

MBA -

Roseman University of Health Sciences

Doctor of Pharmacy (PharmD) -

Roseman University of Health Sciences

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