Salica Jonik
Conway,SC
Summary
Accomplished operations manager with over 20 years of experience in the healthcare industry. Possessing extensive knowledge of product management and implementation processes, I have successfully led teams and executed strategies to drive operational efficiency and improve patient outcomes. Proven track record in streamlining processes, optimizing resource allocation, and implementing innovative solutions to enhance overall organizational performance. Results-oriented professional dedicated to delivering exceptional results through effective leadership, strategic planning, and cross-functional collaboration.
Overview
26
26
years of professional experience
Work History
Implementation Specialist Manager
Cigna
07.2022 - Current
- Primarily responsible for managing a team of Implementation Specialist, aligned to complex account installation
- Inventory management, severing as an escalation point of contact for senior leadership and staff, aiding in the prioritization of task related to client implementations
- Collaborating with senior leadership to ensure the organization is successfully delivering on our commitment to provide seamless implementations for all clients
- Oversight and delegation of assignments related to project work
- Collaborating with matrix partners and staff to identify roadblocks within the installation process and implementing process improvements
- Responsible for reviewing staff productivity and quality scores, providing coaching and additional training when necessary
- Assisting Implementation Specialist with career development.
Product Management Advisor
Cigna
01.2019 - 07.2022
- Primarily managed and supported ongoing product development and management of pharmacy benefits for commercial clients
- Managing existing Pharmacy Products that support the objective of improving health outcomes and decreasing total cost of care for customers
- Supporting and developing innovative short and long-term pharmacy benefits as well as incentives to drive sustainable profitability and growth for the commercial market
- Collaborating with the regulatory team to determine the impact of federal and state mandated requirements on Cigna’s standard product offerings
- Providing implementation instructions for matrix partners to ensure client elected benefits and products comply with state and federal mandates
- Maintained RFP repository responses pertaining to pharmacy benefits, also served as a pharmacy subject matter expert providing feedback related to Cigna’s standard pharmacy product offerings and any flexibility that can be offered to potential clients
- Maintained a reference document of Pharmacy Products available for sale based upon the clients funding status and state of situs
- Collaborating with the state filing team to outline product features to be included in state specific filings for fully insured business
- Served as a point of contact responsible for reviewing non-standard pharmacy plan designs escalated by the Product and Benefit Advisory Board Approval Team & Cigna's Exception Review Committee
- Engaged pharmacy Product Leads when necessary to determine the approve/deny decision that supports Cigna Pharmacy Management’s overall strategic goals and priorities
- Determining any downstream/upstream impacts that may arise because of a non-standard pharmacy benefit approval, and ensuring those risk are outlined in the approval or denial decision
- Reviewing nonstandard benefit designs for clients with a Client Specific Pharmacy Network to provide an approve/deny decision.
Pharmacy Implementation Manager
Cigna
01.2014 - 01.2019
- Provided pharmacy support for small business clients in the Southeastern sales market
- Working closely with Implementation Managers and Client Managers to address new and renewing client implementations
- Responsibilities included validating all elected pharmacy benefits are within Cigna Product Standards and State Compliance requirements, while aligning to Cigna’s Go to Market initiatives
- Reviewing Client Benefit Summaries and other plan documents outlining the client’s intent
- Validating all non-standard benefit request have been reviewed though the exceptions process and have the appropriate approvals prior to benefits were submitted a client’s benefits for benefits coding
- Creating training documents for the Pharmacy Implementation Manager Organization
- Providing peers small business training while highlighting differences between Cigna internal platforms
- Triage of pharmacy benefit related issues including pharmacy claims research on the DST claims processing system
- Working with internal partners to update small business engagement processes to ensure PIMs are engaged via strategy call for all new business and account renewals with pharmacy changes.
Pharmacy System Analyst
AmeriHealth Caritas/PerformRX
01.2013 - 01.2014
- Served as the senior-level analyst responsible for the Vendor Relationship Management (DST), while supporting Account Management and Pharmacy Implementation teams to ensure the successful installation of pharmacy benefits for Exchanges, Medicare, and Medicaid clients across the country
- Responsibilities included leading multiple successful onsite Centers for Medicare and Medicaid Services (CMS) audits sessions for various Part D clients
- Gathered client intent regarding pharmacy benefits
- Ensured benefits were within state compliance and CMS guidelines
- Created business requirements for pharmacy coding request
- Prioritized pharmacy benefit coding requests across multiple clients
- Created test macros for all pharmacy benefit changes (new and renewing clients)
- Created training presentations for internal teams and external clients with pharmacy system access
- Created pharmacy presentations for prospective clients
- Provided responses for RFP submissions
- Tracked and trended global pharmacy coding issues
- Collaborated with clients and claims processor during implementation to ensure enrollment feeds were set-up correctly to prevent Access to Care.
Quality Assurance Analyst
CatamaranRX
01.2012 - 01.2013
- Lead quality analyst servicing one of the region’s largest health plans comprised of 1.3 million lives across Commercial, Medicare, and TPA accounts
- Responsible for conducting interviews of potential team members
- Created and reviewed test scripts designed to ensure pharmacy benefits processed as intended at point of service
- Analyzed benefit set up for accuracy to ensure system coding matched the client intent and standard operating procedures, processes, and guidelines
- Created policy and procedure documents used to train Quality Assurance Associates.
Benefit Analyst
CatamaranRX
01.2011 - 01.2012
- Worked with internal operational areas to implement corporate incentives, and programs designed to provide cost effective savings to clients while improving care and drug adherence for members
- Served as consultant for all documentation associated with client benefit design, consistent and in compliance with standards of SAS70, and URAC
- Gathered information needed to create project related business requirements and submitting coding request
- Created analysis used to determine the potential impact of coding changes such as prior authorizations and quantity restrictions
- Worked with internal operational areas to provide information necessary to create member and client communications related to corporate incentives.
Client Service Manager
CatamaranRX
01.2008 - 01.2012
- Responsible for the management and enhancement of the client’s day to day interactions with the PBM from an operational standpoint
- Supported the Account Management and Implementation teams with special projects and client meetings when needed
- Successfully implemented new processes to improve services provided by external vendors
- Mail order vendor migration
- Worked closely with the client and internal operational areas to address concerns with member eligibility, benefit step up, and deductible feeds
- Collaborated with senior management to make necessary improvements to satisfy the client's needs
- Continually improved knowledge, skills, and performance based on feedback and self-identified professional developmental needs
- Provided weekly project status updates to Product Management.
Client Service Support Representative / Patient Care Advocate
Express-Scripts
01.1999 - 01.2008
- Served as the day-to-day contact with clients for issue resolution by handling inbound client calls and written correspondence while maintaining service levels
- Made independent judgments to respond to complex or critical customer issues
- Worked with other operational departments to research and resolve mail order and claims issues and respond to clients and account managers within performance agreement guidelines
- Identified, documented, and reported all repetitive questions and/or problems and recommend potential solutions
- Dedication and an excellent service satisfaction rating, propelled promotion
- Served as SME for client service escalations, provided resolution to senior level escalations in both client and company favor.
Education
No Degree - Project Management
Cornell University
Ithaca, NY09-2024
Skills
- Project Management
- Diverse Team Building & Leadership
- Vendor Oversight
- Problem Solving
- Complex Issue Management and Resolution
- Compliance
Timeline
Implementation Specialist Manager
Cigna
07.2022 - Current
Product Management Advisor
Cigna
01.2019 - 07.2022
Pharmacy Implementation Manager
Cigna
01.2014 - 01.2019
Pharmacy System Analyst
AmeriHealth Caritas/PerformRX
01.2013 - 01.2014
Quality Assurance Analyst
CatamaranRX
01.2012 - 01.2013
Benefit Analyst
CatamaranRX
01.2011 - 01.2012
Client Service Manager
CatamaranRX
01.2008 - 01.2012
Client Service Support Representative / Patient Care Advocate
Express-Scripts
01.1999 - 01.2008
No Degree - Project Management
Cornell University
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