Sarah Grundy
Reno
Summary
Results-driven Healthcare Leader with 8+ years of progressive experience in talent acquisition, employee training & development, performance management, team leadership, and regulatory compliance in Medicare Advantage and pharmacy operations. Proven success in interviewing, hiring, onboarding, training high-performing teams, developing policies/procedures, tracking KPIs, and driving member engagement/adherence programs. Seeking to leverage strong people-management, recruitment, and leadership skills in an HR Generalist, Talent Acquisition, or Training & Development role.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Member Service Guide - Pharmacy Outbound Manager
Devoted Health Plan
Reno, NV
06.2023 - Current
- Lead and manage outbound pharmacy member service team, directing daily outbound calling campaigns to engage members, remove barriers to medication access, and improve adherence rates.
- Implemented and managed Medication Adherence Program responsible for engaging membership to assist in removing barriers in filling medications on a regular basis.
- Assisted in implementation and ongoing management of Medicare Outreach Program with focus on outbound engagement.
- Fully trained new and internal team members as well as delegate team members on Medicare Outreach efforts, including scripting, mock calls, and plan document education.
- Subject matter expert for Medicare and Medicare Advantage; provide guidance and support to member service guides on outbound interactions.
- Functioned as liaison internally between Members, Care Advocate team members and the on-staff Pharmacist and externally between providers, members and the PBM.
- Worked intimately with Pharmacy Benefits Manager MedImpact to ensure member needs are met and pharmacy benefits are optimized.
- Developed and tracked department KPIs and output related to CMS Part D Star Ratings (SPC, SUPD, MTM CMR Completion Rate, Medication Adherence for Hypertension (RAS), Cholesterol (Statins), and Diabetes).
- Established and put into effect team workflows, operational processes, policies, and procedures for outbound member services.
- In charge of selecting, interviewing, and onboarding pharmacy technicians for various positions.
- Working knowledge of Commercial, Self-Funded and Medicare Advantage formularies.
- Comprehensive understanding of adverse benefit determinations, appeals and grievance policies as they relate to Medicare, Commercial and Self-Funded products.
- Detailed knowledge and understanding of EOCs, SOBs and SPDs for Exchange, Commercial, MA and Self-Funded lines of business.
- Working knowledge of Customer Service Applications such as Health Axis, SharePoint, SmartSheet, Softeon, QNXT and Red Card.
- Works closely with various departments within PHP and Delegates to enhance the Customer Experience.
- Manage incoming/outbound calls for commercial and MA members.
Pharmacy Quality Manager
Prominence Health Plan
Reno, NV
10.2017 - 06.2023
- Implemented and managed Medication Adherence Program responsible for engaging membership to assist in removing barriers in filling medications on a regular basis.
- Created standard operating procedures or quality assurance manuals to refine production processes or update for conformity to new regulations or policies.
- Managed incoming calls for commercial and MA members.
- Assisted in implementation of Medicare Outreach Program.
- Fully trained new and internal team members as well as delegate team members on Medicare Outreach efforts, including scripting, mock calls, and plan document education.
- Detailed knowledge and understanding of EOCs, SOBs and SPDs for Exchange, Commercial, MA and Self-Funded lines of business.
- Working knowledge of Customer Service Applications such as Health Axis, SharePoint, SmartSheet, Softeon, QNXT and Red Card.
- Works closely with various departments within PHP and Delegates to enhance the Customer Experience.
- Subject matter expert for Medicare and Medicare Advantage.
- Functioned as liaison internally between Members, Care Advocate team members and the on-staff Pharmacist and externally between providers, members and the PBM.
- Worked intimately with Pharmacy Benefits Manager MedImpact to ensure member needs are met.
- Working knowledge of Commercial, Self-Funded and Medicare Advantage formularies.
- Comprehensive understanding of adverse benefit determinations, appeals and grievance policies as they relate to the Medicare, Commercial and Self-Funded products.
- Developed and tracked department KPIs and output.
- Established and put into effect team workflows, operational processes, policies, and procedures.
- In charge of selecting pharmacy technicians for various positions.
- Working knowledge of the metrics used by CMS Part D Star Ratings (SPC, MTM Program Completion Rate for CMR, SUPD, Medication Adherence for Hypertension (RAS antagonists), Cholesterol (Statins), and Diabetes Medications).
Lead Pharmacy Technician
Savemart Pharmacy
Sparks, NV
05.2014 - 10.2017
- Supervised daily pharmacy operations and led a team of technicians
- Recruited, interviewed, trained, and developed new hires and pharmacy students
- Created weekly schedules, managed workflow, and ensured timely order fulfillment
- Maintained strict compliance with federal, state, and company regulations
Pharmacy Technician
Walmart Pharmacy (Reno, NV) • CVS Pharmacy (Reno, NV) • Savemart Pharmacy (Sparks, NV)
01.2010 - 01.2014
- Delivered high-level customer service while adhering to all regulatory standards
- Trained and mentored new team members and interns
- Supported inventory management and operational efficiency
Auditor / Sales Clerk
Saks OFF 5TH
Katy, TX
10.2011 - 08.2012
- Promoted to Auditor within 3 months; managed cash reconciliation, petty cash, and high-value inventory controls
Pharmacy Technician
Savemart Pharmacy
Sparks, NV
09.2000 - 01.2010
- Filled prescriptions and ensured top-tier customer service with full regulatory compliance
Education
High School Diploma -
Sparks High School
Sparks, NV06.2000
Skills
- Talent Acquisition & Interviewing
- Employee Training, Onboarding & Development
- Team Leadership & Supervision
- Performance Management & KPI Tracking
- Policy, Procedure & Workflow Development
- Employee Scheduling & Workforce Management
- Regulatory Compliance (Federal, State, CMS Part D Star Ratings)
- Member & Employee Engagement / Outreach Programs
- Data Analytics & Reporting (Power BI, SmartSheet)
- Microsoft Office Suite (Word, Excel, PowerPoint), Visio, SharePoint
Certification
- Certified Pharmacy Technician (CPhT) – Pharmacy Technician Certification Board (PTCB)
- M3 Leadership Program – Prominence Health Plan, 2017
Timeline
Member Service Guide - Pharmacy Outbound Manager
Devoted Health Plan
06.2023 - Current
Pharmacy Quality Manager
Prominence Health Plan
10.2017 - 06.2023
Lead Pharmacy Technician
Savemart Pharmacy
05.2014 - 10.2017
Auditor / Sales Clerk
Saks OFF 5TH
10.2011 - 08.2012
Pharmacy Technician
Walmart Pharmacy (Reno, NV) • CVS Pharmacy (Reno, NV) • Savemart Pharmacy (Sparks, NV)
01.2010 - 01.2014
Pharmacy Technician
Savemart Pharmacy
09.2000 - 01.2010
High School Diploma -
Sparks High School