Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Salica Jonik

Conway

Summary

Accomplished operations manager with over 20 years of experience in the healthcare industry, with 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

27
27
years of professional experience

Work History

Implementation Specialist Manager

Cigna
07.2022 - Current
  • Primarily responsible for managing a team of Implementation Specialists, aligned to complex account installations.
  • Attending client readiness calls in support of my staff and matrix partners.
  • Inventory management, serving as an escalation point of contact for senior leadership and staff, aiding in the prioritization of tasks 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.
  • Collaborating with training teams to ensure staff knowledge of new product offerings and installation changes.
  • Assisting the 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.
  • Attending client calls in support of the sales team to address nonstandard benefit/product requests.
  • Managing existing pharmacy products that support the objective of improving health outcomes and decreasing the 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 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, 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 on 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, and 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 or upstream impacts that may arise because of a non-standard pharmacy benefit approval, and ensuring those risks 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 clients in the Southeastern sales market.
  • Working closely with Implementation Managers and Client Managers to address new and renewing client implementations.
  • Participating in client readiness calls.
  • Ensure client-elected pharmacy benefits are in accordance with our product standards, while also meeting state compliance requirements.
  • Reviewing client benefit summaries and other plan documents correctly outlines the client's intended benefits.
  • Validated that all non-standard benefit requests had the appropriate approvals through the exceptions process.
  • Creating training documents for the Pharmacy Implementation Manager Organization.
  • Provided peer training specific to small business accounts.
  • 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 streamline the small business implementation process.

Pharmacy System Analyst

AmeriHealth Caritas/PerformRX
01.2013 - 01.2014
  • Served as the senior-level analyst responsible for 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) audit sessions for various Part D clients.
  • Participated in client readiness and finalist meetings.
  • Gathered client intent regarding pharmacy benefits.
  • Ensured that benefits were within state compliance and CMS guidelines.
  • Created business requirements for the pharmacy coding request.
  • Prioritized pharmacy benefit coding requests across multiple clients.
  • Created test macros for all pharmacy benefit changes, including 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 processors 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 that pharmacy benefits are processed as intended at the 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
  • 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 the 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 improve 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 internal 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 problems, and recommended potential solutions.
  • Dedication and an excellent service satisfaction rating propelled promotion.
  • Served as an SME for client service escalations, and provided resolution to senior-level escalations in both client and company favor.

Education

Project Management -

Cornell University
Ithaca, NY
09.2024

Skills

  • Project coordination
  • Project management
  • Process improvement
  • Client relations
  • Compliance oversight
  • Complex issue resolution
  • Customer support
  • Client training

References

References available upon request.

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

Project Management -

Cornell University

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