Summary
Overview
Work History
Education
Skills
Certification
Community Service
Awards
Affiliations
Accomplishments
References
Timeline
Generic

Michelle Lawrence

Grapevine

Summary

Dynamic healthcare executive with extensive experience in the heatlhcare industry, specializing in pharmacy operations and strategic partnerships. Proven track record in achieving over millions in savings through innovative project management and visionary leadership. Adept at financial analysis and fostering cross-functional collaboration to drive organizational growth and enhance patient care outcomes.

Overview

17
17
years of professional experience
1
1
Certification

Work History

Director, Payor Relations

FreseniusRx
01.2024 - Current
  • Oversee and direct the functions and activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs for Payor Relations.
  • Oversee contractual relationships with managed care organizations and other third-party payors regarding rate structures for services, clinical and financial reporting obligations, the establishment of other business terms per FMCNA guidelines, and contract maintenance, such as facility list updates and amendments.
  • Provide strategic leadership of short- and long-term goals using thoughtful techniques in the communication of the company's mission and core values to implement positive change and/or create an organizational structure within the assigned business unit(s).
  • Lead operational efforts to complete the administration of business processes and services to ensure the operation's effective achievement of goals within the assigned business unit(s).
  • Direct and control the broad activities of the business unit(s) through the interpretation, application, and implementation of company-wide policies and processes appropriate to the functional area(s).
  • Developed and lead the company’s Continuous Quality Improvement (CQI) program.
  • Project lead for URAC and DMEPOS accreditations.
  • Lead the audit team in preventing payor financial recoupments. The Payor Relations team effectively saved over $6 million in 2024.
  • Provide leadership, guidance, and coaching for all direct reports to maintain an engaged and productive workforce.
  • Collaborate with internal departments and external customers/vendors in problem resolution.
  • Responsible for hiring, coaching, and counseling employees, including performance reviews, disciplinary actions, and terminations.
  • Identify, analyze, and interpret key industry trends to identify strategic growth opportunities, provide strategic recommendations, and negotiate with payor partners.
  • Develop and maintain strategic relationships with a multitude of payors, including PBMs, health plans, regional health plans, government payors, and other large payors.
  • Develop and foster strong, positive working relationships with existing and future payors to maximize opportunities and promote the company's value proposition.
  • Serve as a subject matter expert on complex insurance and payor-related activities with the management and executive teams.
  • Present high-level contract proposals, and market and industry analyses to internal parties, and respond to requests for proposals from third-party payors.
  • Develop, implement, and manage various programs that enhance payor partnerships, and grow Fresenius' share and profitability. Programs include, but are not limited to, preferred networks, Medication Therapy Management (MTM), and other value-based reimbursement systems.

Director/Senior Manager, Clinical Pharmacy

Aetna CVS Health
09.2016 - 10.2023
  • Collaborated with Joint Venture (JV) and Accountable Care Organization (ACO) provider partners to ensure the execution of pharmacy and other clinical initiatives, with a focus on partnering with both internal and external constituents to ensure that programs and workflows were delivered timely and accurately.
  • Responsible for and accountable to multiple JVs and ACOs, in partnership with nationally recognized healthcare institutions (Texas Health Resources (THR, TX), Banner Health (AZ), Allina Health (MN), Inova Health System (VA), and Sutter Health (CA)), among the top five.
  • Evaluated pharmacy trends and prescribing provider practices for cost improvement opportunities.
  • Identified appropriate provider-prescribing initiatives, and developed action-oriented reports and new programs, workflows, and processes to meet business results.
  • Drove and guided the development of solutions and strategic plans, and provided recommendations around the identification and implementation of transformation programs within the client organization to improve quality, increase efficiency, and drive cost savings.
  • Proactively identified opportunities for improvement and influenced business leaders to change behavior through negotiations and/or consultations that promoted issue resolution.
  • Worked with the marketing and sales teams to develop messaging regarding the value-add of the business unit.
  • Collaborated with business partners to provide advice on metrics, tools, and outcomes models for the development and evaluation of projects and programs.
  • Developed clinical initiatives and strategies in partnership with chief medical officers and other clinicians.
  • Communicated compelling, concise results to empower business partners in decision-making.
  • Designed a SharePoint site to educate clinician colleagues on the Rx pipeline and pharmacy initiatives.
  • Developed compelling business plans to drive formulary adherence and specialty Rx management.
  • Supported pharmacy cost savings exceeding $10 million.
  • Supported the RFP process in collaboration with the Product, PBM, Marketing, and Sales teams.
  • Collaborated with other payers, clinicians, and educators in Medication Therapy Management (MTM).

Director of Pharmacy

Forest Park Medical Center Fort Worth (FPMCFW)
01.2014 - 07.2016
  • Directed a 54-bed surgical and acute care hospital pharmacy department.
  • Responsibilities included operations management of the pharmacy department at FPMCFW, and consultative support for other FPMC facilities.
  • Involved in organizational strategic planning and decision-making processes.
  • Managed the development and implementation of the pharmacy services department at a ground-up facility.
  • Developed and managed the medication formulary, as well as the medication acquisition and distribution processes.
  • Managed and helped develop an annual drug budget of over $800,000 and oversaw the drug utilization process.
  • Developed departmental policies, procedures, and protocols that optimized therapeutic outcomes, reduced the risk of drug-related problems, and ensured the use of cost-effective pharmacotherapy.
  • Ensured compliance with all national, state, and local regulations related to medication utilization.
  • Responsible for all pharmaceutical contracting, procurement, receiving, security, inventory control, diversion prevention, and distribution policies and processes, including vendor analysis and selection.
  • Oversaw Pharmacy, Nutrition, & Therapeutics (PN&T) Committee meetings.
  • Active member of the Medical Executive Committee (MEC), Quality Council, Infection Control Committee, Environment of Care Committee, Senior Leadership, and Medication Management Performance Improvement Team.

Chief Executive Officer

LifeCare Hospitals of Dallas
01.2013 - 01.2014
  • Responsible for the overall strategic planning, leadership, business development, patient quality care and outcomes, and building physician relationships.
  • Spearheaded strategic initiatives throughout the hospital, focusing on setting goals, objectives, and targets across all administrative functions of the hospital.
  • Ensured the hospital conformed with regulatory and inspection agency requirements.
  • Prepared the annual budget for review, including department sub-budgets that demonstrated expected revenues and expenditures; ensured fiscal responsibility across all departments and functions.
  • Developed strong business relationships with the physician community, and served as a liaison and channel of communication between the Board of Directors and the Medical Staff.
  • Determined patient quality and outcomes measures to ensure high quality of patient care in an ethical manner.
  • Prepared and planned for the achievement of the hospital’s specific objectives through the establishment of formal means of accountability with department directors.
  • Oversaw development and implementation of corporate policies and procedures.
  • Developed strategic plans and objectives to ensure organizational growth and profitability.
  • Directed the implementation of new business initiatives from concept through completion.

Corporate Vice President of Pharmacy Operations

GlobalRehab Management
01.2008 - 01.2013
  • Responsible for the strategic planning, organization, expansion of services, clinical program development, and management of hospital pharmacies.
  • Set direction and provided overall accountability for regional and site leadership, management of the corporate business unit, and delivery of core services.
  • Developed, implemented, and enforced policies that governed operations, financial performance, and performance management initiatives.
  • Managed and directed the following: three 42-bed inpatient rehabilitation hospital pharmacy departments in San Antonio, Dallas, and Fort Worth, TX; a 67-bed long-term acute care hospital (LTACH) pharmacy in Dallas, TX; and a 50-bed inpatient rehabilitation hospital pharmacy in Scottsdale, AZ.
  • Department project manager for four hospital startups in Dallas, Fort Worth, San Antonio, and Scottsdale.
  • Responsibilities included strategic planning, financial management, regulatory management, and operations management of the pharmacy departments.
  • Directly supervised four hospital directors of pharmacy.
  • Involved in the organization’s strategic planning and decision-making processes for future hospital acquisitions and ongoing operational oversight.
  • Developed compliance programs for adherence to both regulatory and financial standards and regulations.
  • Developed cost reduction programs for internal and external operations.
  • Responsible for the development and implementation of the medication formulary for all facilities.
  • Oversaw medication processing, distribution systems acquisition, and integration.
  • Planned, developed, and managed a pharmacy $1.85 million annual drug budget.
  • Developed and oversaw the departmental regulatory and quality assurance program.
  • Oversaw and coordinated Pharmacy and Therapeutics (P&T) Committees for all hospitals.
  • Responsible for the department’s compliance with the Healthcare Facilities Accreditation Program (HFAP), The Joint Commission (TJC), and Texas State Board of Pharmacy (TSBP) surveys.
  • Directed pharmaceutical contracting, procurement, receiving, security, inventory control, diversion prevention, and distribution, including vendor identification and management.
  • Increased the hospital pharmacy division’s profit margin through cost-saving initiatives.
  • Developed a system-wide clinical pharmacy program, resulting in improved drug utilization through the influencing of physician prescribing patterns, and compliance with industry standards of care.
  • Directed an interdisciplinary standardization team that led to consistent practices across the enterprise.
  • Established key performance indicators to measure success of projects, programs, and initiatives.
  • Managed budgeting processes for the organization, monitoring spending and performance metrics.
  • Maintained regular communication with board of directors regarding financial performance and other matters.
  • Collaborated with internal departments on planning, forecasting, and resource allocation.

Interim Chief Executive Officer

Texas Specialty Hospital
  • Provided interim administrative and leadership support for a 67-bed long-term acute care hospital.
  • Directed company operations to meet budget and financial targets.
  • Consulted with members of the Medical Staff, and the Board of Trustees, in developing strategic direction, and policy and protocol development.
  • Collaborated with the Chief Marketing Officer and the Director of Business Development in developing marketing strategies to recruit physicians, and drive patient referrals.
  • Established policies, procedures, and protocols to improve operational efficiency.
  • Oversaw budgetary and financial activities and implemented strategies to grow business and profits.

Director of Pharmacy and Hospital Operations Consultant

BGS Pharmacy Partners
  • Directed the pharmacy department and consulted for this independent specialty pharmacy company, with service lines including acute and sub-acute care, long-term acute care, hospice, and specialty home intravenous (IV) services.
  • Directed and consulted on operations management and clinical program development.
  • Developed a budget aligned with organizational and departmental objectives.
  • Implemented systems to monitor patient outcomes and improve overall quality of care.
  • Administered fiscal operations for accounting, budget planning, authorizing expenditures and coordinating reporting.
  • Monitored medication purchasing activities to maintain compliance with applicable laws and regulations.
  • Consulted for start-up processes at regional acute-care hospitals.

Director of Pharmacy

Integra Hospital Plano
  • Directed the pharmacy department of a 73-bed rehabilitation and skilled nursing unit facility.
  • Responsibilities included operations management of the pharmacy department at IHP, and consultative support for other Integra Hospital Management (IHM) facilities.
  • Involved in the organization’s strategic planning and decision-making processes
  • Managed the development and implementation of the pharmacy department at a ground-up facility.
  • Developed the hospital medication formulary.
  • Oversaw medication processing, distribution systems acquisition, and integration.
  • Oversaw drug utilization management.
  • Developed departmental policies, procedures, and protocols
  • Responsible for budget planning and management.
  • Ensured compliance with all national, state, and local regulations related to medication utilization
  • Responsible for all pharmaceutical contracting, procurement, receiving, security, inventory control, diversion prevention, and distribution policies, including vendor analysis and selection
  • Oversaw PN&T Committee meetings and was an active member of Medical Executive Committee, Quality Council, Infection Control Committee, Environment of Care Committee, and Senior Leadership

Director of Pharmacy

Kindred Hospital Dallas
  • Directed a 110-bed long-term acute care facility's pharmacy department.
  • Responsibilities included interdisciplinary and interdepartmental communications, budget oversight, and overall operations management.
  • Facilitated Pharmacy, Nutrition, and Therapeutics (PN&T) Committee meetings for two hospitals.
  • Oversaw pharmacy-managed clinical programs.
  • Managed the pharmacy’s $1.5 million annual budget.
  • Member of the Corporate Pharmacy Standards Committee and the Medication Management Taskforce.
  • Developed and implemented pharmacy policies and procedures.
  • Member of the Regional Diabetes Management Taskforce.
  • Recognized expert in pharmacy operations; selected from among 50+ pharmacy directors to provide on-site consultation for seven Kindred pharmacies.

Naval Officer, Dept. Head, Pharmacist, Medical Service Corps

United States Navy
  • Assistant Department Head, U.S. Naval Hospital (USNH) Rota, Spain; Pharmacist/Officer-in-Charge, Navy Exchange Pharmacy, Naval Medical Center San Diego (NMCSD); Clinical Staff Pharmacist, NMCSD.
  • Served as an Ensign (ENS), Lieutenant (junior grade) (LTJG), and Lieutenant (LT), receiving exceptional scores on Fitness Reports (FITREP), and promoting very quickly in rank.
  • Responsibilities included interdisciplinary and interdepartmental communications, and overall operations management.
  • Managed inventory control procedures and medication returns process.
  • Maintained Commanding Officer (CO) watch-standing duties for the entire hospital in Rota, Spain.

Education

Doctor of Pharmacy -

Idaho State University

Master of Business Administration -

Texas Woman’s University

B.S. - Biomedical Science

Texas A&M University

B.S. - Pharmacy

The University of Texas at Austin

Master of Human Relations -

The University of Oklahoma

Skills

  • Pharmacy and Healthcare Operations
  • Clinical and Project Management
  • Regulatory and Compliance
  • Budgeting and Account Management
  • Marketing and Sales
  • Business Strategy and Development
  • Partnerships and Alliances
  • Visionary Leadership
  • Cross-functional Team Leadership
  • Coaching and Mentoring
  • Financial Analysis
  • Creativity and Innovation
  • Strategic Planning
  • Market Analysis
  • Client Relations
  • Product and Content Development

Certification

  • Pharmacy License #35877, Texas State Board of Pharmacy
  • Pharmacy License #PS 68140, Florida Board of Pharmacy
  • Pharmacy-Based Immunization Delivery
  • Certified in IV Administration
  • Pharmacy Spanish Program
  • Emergency Medical Technician (EMT-B) (inactive)
  • National Registry of Emergency Medical Technicians

Community Service

  • Team Rubicon, Disaster relief volunteer and DFW District Coordinator, Operation EaDO, Houston, TX, 2017, Operation Amberjack, Marianna, FL, 2018
  • Carroll Independent School District (CISD), CISD Odyssey of the Mind (2nd grade team coach), Student Health Advisory Council (SHAC), CISD Medical Academy (health care career day speaker), CISD Gifted & Talented Program Advisory Committee, Scholars & Athletes Serving Others (SASO) parent volunteer
  • Other, Feed the City, Mission Arlington, Equestrian Therapeutic Horsemanship Facility – Veterans Day, Citizens Academy (local police and fire department, EMS program), Miracle League of Southlake, Tarrant County Area Food Bank Volunteer

Awards

  • Phi Kappa Phi National Honor Society
  • Rho Chi Academic Honor Society in Pharmacy
  • Navy Marine Corps Achievement Medal (NAM)
  • South Region Director of the Year, KPS (2005)
  • Sigma Beta Delta International Honor Society in Business, Management and Administration

Affiliations

Team Rubicon – Disaster relief volunteer and DFW District Coordinator:

- Deployments: Operation EaDO (Houston, TX) post Hurricane Harvey (2017) and Operation Amberjack (Marianna, FL) post Hurricane Michael (2018).

- Partnered with Habitat for Humanity for local, volunteer home building activities.

- DFW District Coordinator (Dec. 2018 – August 2019): Local leadership and team building activities.

Carroll Independent School District (CISD):

- CISD Odyssey of the Mind (2nd grade team coach), Student Health Advisory Council (SHAC), CISD Medical Academy (health care career day speaker), CISD Gifted & Talented Program Advisory Committee, Scholars & Athletes Serving Others (SASO) parent volunteer.

Other:

- Feed the City, Mission Arlington, Equestrian Therapeutic Horsemanship Facility (Veterans Day volunteer)

- Citizens Academy (local police and fire department, EMS program)

- Miracle League of Southlake

- Wreaths Across America

- Tarrant County Area Food Bank Volunteer

Accomplishments

  • Phi Kappa Phi National Honor Society
  • Rho Chi Academic Honor Society in Pharmacy
  • South Region Director of the Year, KPS (2005)
  • Navy Marine Corps Achievement Medal (NAM) and other U.S. Navy service medals
  • Sigma Beta Delta International Honor Society in Business, Management and Administration
  • Combat Casualty Care Course (C4) - U.S. Navy

References

References available upon request.

Timeline

Director, Payor Relations

FreseniusRx
01.2024 - Current

Director/Senior Manager, Clinical Pharmacy

Aetna CVS Health
09.2016 - 10.2023

Director of Pharmacy

Forest Park Medical Center Fort Worth (FPMCFW)
01.2014 - 07.2016

Chief Executive Officer

LifeCare Hospitals of Dallas
01.2013 - 01.2014

Corporate Vice President of Pharmacy Operations

GlobalRehab Management
01.2008 - 01.2013

Interim Chief Executive Officer

Texas Specialty Hospital

Director of Pharmacy and Hospital Operations Consultant

BGS Pharmacy Partners

Director of Pharmacy

Integra Hospital Plano

Director of Pharmacy

Kindred Hospital Dallas

Naval Officer, Dept. Head, Pharmacist, Medical Service Corps

United States Navy

Doctor of Pharmacy -

Idaho State University

Master of Business Administration -

Texas Woman’s University

B.S. - Biomedical Science

Texas A&M University

B.S. - Pharmacy

The University of Texas at Austin

Master of Human Relations -

The University of Oklahoma

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Michelle Lawrence