LISA DRUMM
Dexter,NY
Summary
Healthcare management professional with over 30+ combined years of experience in Pharmacy Benefit Management, Medicaid Managed Care Organization (MCO) operations and Department of Defense (DoD) military treatment facility operations. Skilled in health care implementations, contract management and regulatory/compliance oversight. Leadership expertise in policy development, regulatory review, audits, cross-functional team building and best practices. Extensive experience managing staff and managing Medicaid and DoD contract oversight.
Overview
34
34
years of professional experience
Work History
Program Manager & Process Expert Sr.
CarelonRx (a Subsidiary of Elevance Health)
04.2022 - 09.2024
- Streamlined processes for increased productivity through the use of automation tools.
- Communicated effectively with stakeholders to align expectations, gather requirements, and provide updates on project progress.
- Ensured regulatory compliance by closely monitoring adherence to industry standards and guidelines throughout the program lifecycle.
- Interacted with customers and clients to identify business needs and requirements.
- Managed and supervised administrative and daily program operations, complying with policies and regulations.
Health Plan Compliance Director & Regulatory Oversight
Elevance Health
04.2021 - 04.2022
- Responsible for directing foundational and strategic compliance responsibilities with consistent excellence that support the health plan team and senior leadership
- Directs regulatory audits or exams, internal audits, on-site reviews, risk assessments, audit planning, manages audit evidence preparation and assesses audit preparedness
- Engages directly with auditors and state regulators and develops strong working relationships
- Leads health plan compliance monitoring to identify process gaps, validate compliance levels, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations
Regulatory Manager
Elevance Health
08.2017 - 04.2021
- Communicated state and federal laws and regulations throughout the company
- Subject matter expert of Medicaid contracts, rules and regulations governing business operations and State Agency expectations with responsibility for educating and advising the business
- Primary liaison with the State Agency Contract Manager, facilitating communications between the parties and ensuring an organizational focus on meeting contractual obligations and State Agency deliverables
- Coordinates regulatory reporting deliverables, ensuring timeliness, accuracy and completeness of report and data submissions to the State Agency.
Compliance Manager, Pharmacy Benefits
Elevance Health
05.2013 - 08.2017
- Managed the pharmacy regulatory and compliance services for multiple Medicaid contracts
- Operated as the pharmacy department internal subject matter expert in the education of health plan and corporate staff on market and product specific pharmacy regulatory and contractual requirements
- Maintained ongoing regulatory and compliance oversight of Pharmacy Benefit Manager (PBM)
- Ensured accurate and timely submission of state-mandated regulatory reports for multiple Medicaid contracts
- Led the review, preparation and submission of pharmacy related materials for state audits and readiness reviews required for contract implementations
- Ensured the review, communication and implementation of new or revised state compliance alerts, state and federal regulations, legislation, and other state or federal issued guidance material related to pharmacy and the PBM.
Manager, Pharmacy Benefits Administration
Elevance Health
04.2011 - 05.2013
- Provided leadership and oversight related to the operations of formulary and drug file communications as well as pharmacy benefit designs and modifications
- Established standard operational procedures and oversaw execution by the contracted Pharmacy Benefits Manager (PBM)
- Led cross functional teams to ensure accuracy and timeliness of deliverables related to specific pharmacy benefit savings initiatives
- Managed a team of claims resolution analysts in a systematic and ongoing pharmacy claims surveillance program to ensure pharmacy claims were processing as intended
- Ensured PBM coding issues were identified and resolved and opportunities to minimize risks of fraud, waste, abuse and misuse were appropriately addressed
Chief Hospital Corpsman
U.S. Navy, Active Duty
12.1990 - 12.2010
- Feb 2009-Dec 2010: Leading Chief Hospital Corpsman, Patient Administration Department and Pastoral Care Services Department at Naval Medical Center, Portsmouth, Virginia
- Jan 2002-Jan 2009: Program Coordinator, DoD Pharmacoeconomic Center, Fort Sam Houston, Texas
- Dec 1990-Dec 2001: Various assignments as Lead Hospital Corpsman with oversight, management, training and evaluation responsibilities of active-duty Navy sailors.
Education
Bachelor of Science - Health Care Management
Associate of Science - Management
Skills
- Problem-Solving
- Detail Oriented
- Process Improvement
- Project Coordination
- MS Office Applications
- Work Planning and Prioritization
- Operations Management
- Quality Assurance Evaluation
- Regulatory Compliance
- Decision-Making
Timeline
Program Manager & Process Expert Sr.
CarelonRx (a Subsidiary of Elevance Health)
04.2022 - 09.2024
Health Plan Compliance Director & Regulatory Oversight
Elevance Health
04.2021 - 04.2022
Regulatory Manager
Elevance Health
08.2017 - 04.2021
Compliance Manager, Pharmacy Benefits
Elevance Health
05.2013 - 08.2017
Manager, Pharmacy Benefits Administration
Elevance Health
04.2011 - 05.2013
Chief Hospital Corpsman
U.S. Navy, Active Duty
12.1990 - 12.2010
Bachelor of Science - Health Care Management
Associate of Science - Management
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